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BIRTH CONTROL 

WHAT IT IS 

HOW IT WORKS 

WHAT IT WILL DO 



The Proceedings of the 

First American Birth Control Conference 

Held at the Hotel Plaza, New York 

November, 11, 12, 1921 



Published by 
THE BIRTH CONTROL REVIEW 

104 Fifth Ave., New York 



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GRAPHIC PRESS 
NEW YORK 



TABLE OF CONTENTS 

Introductory Note 1 

Programme of Conference 9 

First Session 12 

Margaret Sanger 14 

Dr. John C. Vaughan 18 

Dr. A. B. Wolfe 21 

Reynold A. Spaeth, Ph. D 29 

*^ Dr. Adolphus Knopf 31 

Dr. Abraham Myerson 36 

Dr. Alice Butler 37 

Dr. Lydia Allen DeVilbiss 39 

Dr. Adolph Myer 46 

Discussion , 48 

Second Session — 

Dr. Aaron J. Rosanoff 53 

Roswell H. Johnson 56 

' Dr. C. C. Little 58 

Virginia C. Young 60 

E. C. Lindemann 66 

Hariette W. Dilla 74 

J. 0. P. Bland 82 

Discussion 85 

Third Session — 

Lothrop Stoddard 94 

James Maurer 102 

Harold Cox 111 

Discussion 119 

Fourth Session — 

-- Dr. C. V. Drysdale 123 

Dr. Andre Tridon 139 

Herman M. Bernelot Moens 148 

Mary Winsor 151 

Petitions 157 

Discussion 158 



111 



TABLE OF CONTENTS (Continued) 

The Public Meeting 163 

-Harold Cox 164 

Margaret Sanger 170 

Is Birth Control Moral, Symposium 175 

Edward Carpenter 176 

Havelock Ellis 177 

Dean Inge 177 

Samuel Hopkins Adams 179 

Katharine Anthony 180 

E. C. Barker 180 

Bernard I. Bell 181 

Edwin W. Bowen 182 

Frederick A. Bushee 182 

Pearce Butler 182 

W. B. Cannon 183 

Will Durant 184 

Warner Fite 184 

Franklin H. Giddings 186 

Ernest H. Gruening 186 

Cosmo Hamilton 188 

John Haynes Holmes , 188 

Fannie Hurst 189 

Mary Johnston 190 

David Starr Jordan 190 

Ben. B. Lindsey 191 

Owen R. Lovejoy 193 

Eden and Cedar Paul 193 

George Foster Peabody 195 

Charles Edward Pell 195 

Mary Scharlieb 198 

Mary Kingsbury Simkhovitch 200 

John S. Sumner 200 

Virginia Terhune Van de Water 202 

W. F. Willcox 203 

Dr. Norman Haire 204 

The American Birth Control League, Inc 207 

Principles and Aims 207 



IV 



INTRODUCTORY NOTE 

THE First American Birth Control Conference, like every 
great landmark in the history of human progress, grew 
out of an idea. For years Mrs. Margaret Sanger, and her little 
band of faithful helpers, had heen engaged on the lecture plat- 
form, in the columns of the Birth Control Review, in thousands 
of communications with individual men and women, through 
the selling of literature on the streets, and even in jail, in the 
uphill task of bringing Birth Control to the attention of the 
public. In the summer of 1921 she sent out a letter addressed 
to people prominent in biology, medicine, economics, sociology 
and social service, and also to well-known business and pro- 
fessional men, writers and educators. About five hundred of 
these men and women were asked their opinion as to whether 
the time was opportune for a national conference on Birth 
Control and whether in case such a conference were held, they 
would be willing to help financially, by contributing papers, or 
by personal work in connection with it. 

A surprisingly favorable response was received from these 
letters. Replies were received from 40 per cent, of the persons 
addressed and opinion seemed overwhelmingly in favor of the 
calling of a conference. In view of this response, it was 
arranged to call the First American Birth Control Conference 
to meet in New York, November 11, 12, and 13, 1921. From 
among those who had signified their willingness to aid, a large 
Conference Committee was formed, with Mrs. Margaret Sanger 
as chairman. The Committee was made up as follows: 

THE FIRST AMERICAN BIRTH CONTROL 
CONFERENCE COMMITTEE 

Margaret Sanger, Chairman 

Juliet Barrett Rublee, V ice-Chairman 

Anne Kennedy, Executive Secretary 



Z INTRODUCTORY 

Clara Louise Rowe, Extension Secretary 
Frances B. Ackermann, Treasurer 
Edith Houghton Hooker, Chairman of Sessions 
Sara E. Nieman, Hospitality Chairman 

Committee on Resolutions 

Mrs. Lewis L. Delafield Dr. Alice Butler 

Clara Louise Rowe 



Conference Committee 
Mr. & Mrs. Thos. L. ChadbourneMr. Herbert Croly 



Mrs. Thomas W. Lamont 

Winston Churchill 

Lydia Allen DeVilbiss, M.D. 

Professor Irving Fisher 

Donald R. Hooker, M.D. 

Mrs. Wallace Irwin 

Mrs. James Lees Laidlaw 

Mrs. Donn Barber 



Mrs. Dexter Blagden 
Mrs. Frank I. Cobb 
Dr. E. M. East 
William J. Fielding 
Bernarr MacFadden 
Virginia C. Young 
Mary Shaw 
Elizabeth Severn, Ph.D. 



Dr. & Mrs, Frederick Peterson Dr. S. Adolphus Knopf 
Dr. & Mrs. Ernest H. Gruening Mrs. Kate Crane Gartz 



Mrs. Willard Straight 
Mrs. John Winters Brannan 
Frederick C. Haeckel, M.D. 
Mrs. John A. Fry 
Mrs. Stanley McCormick 
Charks G. Taylor, M.D. 
Dr. & Mrs. L. Emmett Holt 
Mrs. Maxfield Parrish 
Mrs. Homer St. Gaudens 
Mrs. Lewis L. Delafield 
Professor Walter B. Pitkin 
Mrs. Charles E. Knoblauch 
Baroness Keikichi Ishimoto 
Lothrop Stoddard, Ph.D. 



Mrs. Henry Villard 
Dr. Alice Hamilton 
Mrs. Shelly Tolhurst 
Mrs. Otto H. Kahn 
Lillian D. Wald 
John Favill, M.D. 
Juliet Barrett Rublee 
Mrs. Dwight Morrow 
Mrs. Pierre Jay 
Rev. Arthur E. Whatham 
Kate W. Baldwin, M.D. 
Mary Halton, M.D. 
Clara W. Carter 
Lowell Brentano 



Rabbi Rudolph I. Coffee, Ph.D.Prof. & Mrs. James A. Field 

Mrs. Learned Hand Dr. Mary I. Bigelow 

Edith Swift, M.D. Mrs. Robert B. Gregory 

Mr. Kendall Banning Mrs. Ernest R. Adee 

Mrs, Ruth W. Porter Bertha Rembaugh 

Dr. Anna Blount Mrs. Robert Bass 

Kenneth Taylor, M.D. Mrs. George H. Day, Sr. 



BIRTH CONTROL 6 

Mrs. William Spinney Mrs. Walton Martin 

Mrs. Charles Tiffany Sara Messing Stern 

Mrs. Ernest Poole Mabel W,ood Hill 

Florence Bayard Hilles Andrew H. Green 

Laura Hickox Young Mrs. William A. McGraw 

John C. Vaughan, M.D. Theodore Dreiser 

Mrs. Arthur L. Lawrence Mrs. Samuel Lambert 

Miss Martha Davis Mary Winsor 

Mr. Robert M. Lovett Florence Guertin Tuttle 

Mrs. Minturn Pinchot John Hays Hammond, Jr. 

Mrs. Simeon Ford Helen Thomas Flexner 
Mrs. C. C. Rumsey 

In arranging the Programme the Committee did not limit it- 
self to the United States. Twenty-four papers in all were pre- 
sented, and all but three were read at the Conference by their 
writers. The three exceptions were the paper of Professor 
Lindeman of North Carolina, ileadj by Mrs. William A. 
McGraw; that of Dr. C. V. Drysdale of London, read by Dr. 
Roswell Johnson, and that of Professor A. B. Wolfe of Texas, 
read by Dr. Sidney E. Goldstein. Two of the speakers were 
from England — Mr. Harold Cox, Editor of the Edinburgh 
Review, who came at the invitation of the Conference Com- 
mittee for the sole purpose of speaking at the Birth Control 
Conference, and Mr. J. 0. P. Bland who was in this country 
in connection with the Disarmament Conference at Washington. 
A paper was read by Professor Moens of Holland, and the rest 
were from American men and women from New York, New 
England, the Atlantic States, the South and the Middle West. 

The papers covered the scientific, economic and political and 
social aspects of the question. The medical aspect was dis- 
cussed at a meeting open only to members of the medical pro- 
fession, held on Friday evening, November 11th. This meet- 
ing revealed the interest taken by the medical profession in 
the subject. The room assigned for the gathering was crowded 
to the doors and many people stood throughout the prolonged 
session. Another point brought out was the very general 
ignorance among doctors concerning hygienic and efl&cient con- 
traceptives. As no branch of medical training undertakes to 
give instruction concerning such contraceptives, this ignorance 



4 INTRODUCTORY 

ought not to be a matter of surprise. It is noted merely to 
show the need of research and clinical experience. The record 
of the proceedings at this meeting has not been published, but 
is in the possession of the American Birth Control League. 

The question of the Morality of Birth Control was reserved 
as the subject for discussion at a public meeting, arranged to 
be held on the evening of November 13th. Through the arbi- 
trary and illegal action of the police this meeting was broken 
up before the speakers had a chance to begin their addresses; 
and two women — Mrs. Margaret Sanger and Miss Mary Winsor 
— were arrested and taken to the police court. They were re- 
leased on their appearance the following morning, as it was 
clear that they had committed no oflfence. Hearings on the out- 
rage were demanded by a committee of independent citizens, 
interested in the right of free speech and free speech and free 
assembly. The demand was granted but hearings dragged 
along for three months, without disciplinary action against the 
offenders responsible for breaking up the meeting being taken 
by the city authorities. 

The meeting was hastily rearranged to be held the following 
Friday, November 18th, at the Park Theatre. This time there 
was no interference attempted. The theatre was filled to 
capacity and huge crowds were turned away. The programme 
as arranged for the Sunday night meeting was carried through, 
the principal speeches being given by Mrs. Margaret Sanger 
and Mr. Harold Cox. 

As a preliminary to the public meeting, Mrs. Sanger had 
sent out some weeks previously a letter asking for replies to the 
four following questions: 

1. Is not over-population a menace to the peace of the 
world? 

2. Would not the legal dissemination of scientific Birth 
Control information through the medium of clinics by 
the medical profession be the most logical method of 
checking the problem of over-population? 

3. Would knowledge of Birth Control change the moral 
attitude of men and women toward the marriage bond, 



BIRTH CONTROL 5 

or lower the moral standards of the youth of the 
country? 
4. Do you believe that knowledge which enables parents lo 
limit their families will make for human happiness and 
raise the moral social and intellectual standards of the 
population? 

The letter was sent to 200 prominent men and women, and 
about fifty detailed replies were received. A selection from 
these replies is given at the close of the volume. 

Exhibits illustrating every phase of the Birth Control ques- 
tion were on view in an ante-room during the whole time over 
which the Conference extended. The Guide to the Exhibits is 
given below. The Conference Committee was indebted to Dr. 
Harritte M. Dilla, member of the Faculty of Economics and 
Sociology of Smith College, Mass., for the collection of ma- 
terial and arrangement of the charts and folios. The photo- 
graphs included in Part V, Division 1, were prepared and pre- 
sented by Mr. Lewis Hine of the National Child Labor Com- 
mittee. 

PART L 
EVIDENCE OF PRESENT SOCIAL WASTAGE 

Division 1. Infant and Maternal Mortality 

A. Twelve charts showing most fatal groups of diseases in 
twelve cities of the United States. Based upon the inter- 
national detailed disease list, Mortality Statistics, 1921, of 
the Census Bureau. 

B. Chart showing these groups of diseases for United States 
as a whole. 

C. Twenty charts showing relation between infant mortality 
and number of children in family, order of birth, employ- 
ment of mother, earnings of father, rental paid, housing 
condition and congestion. Based upon the Field Studies 
of the Children's Bureau in seven industrial cities. 

D. Ten charts showing comparative rates of infant mortality 
in ten cities of the United States. Based upon the Statis- 
tical Report of Infant Mortality for 1920, in 519 Cities of 



b INTRODUCTORY 

the United States, published by American Child Hygiene 
Association. 
E. Chart showing Maternal Mortality in the United States. 

DivisoN 2. Family Pedigrees 
Twelve charts showing persistence or reappearance in fam- 
ily descent, of predisposition to tuberculosis; affections 
of the mucuous membrane; deafness, especially oto- 
sclerosis; venereal infection; mental defect; psychopathic 
and neuropathic instability. Based upon family charts 
from Davenport, Goddard, Healy, Jeliffe and White, and 
Rosanoff. 

Division 3. Social Maladjustment 

A. Three charts showing the extent of insanity, and the rela- 
tion between insanity and economic condition. Based 
upon the Reports of State Hospital Commissions for the 
Insane. 

B. Six charts showing relation between juvenile and adult 
delinquency and congenital psychopathic or neuropathic 
instability, poverty and size of family. Based upon Healy, 
Breckinridge and Abbott, and publications of the Bureau 
of Social Hygiene. 

C. Chart showing correlation between actual and mental age 
of children coming before the Psychopathic Clinic of the 
New York City Juvenile Court. 

D. Selections from One Hundred Neediest Cases. 

PART n. 
THE FOUNDATIONS OF BIRTH CONTROL 

Division 1. Biological Foundations 

A. Six charts showing the processes of maturation, reduction 
and fertilization of the germ cell, and illustrating the con- 
tinuity of the germ plasm. 

B. Six charts illustrating the operation of Galton's Law of 
Ancestral Inheritance, and the Mendelian Law of Domi- 
nant and Recessive Traits. 



BIRTH CONTROL 7 

These charts are based upon plates from Davenport, 
Guyer, Thompson, Walter and others. 

Division 2. Medical Foundations 
Folio Collection of excerpts from professional treatises on 
Gynecology and Obstetrics, establishing the fact of in- 
jurious effect upon pregnancy of such pathological states 
of the mother as tuberculosis, heart and kidney disease, 
pelvic deformity, and venereal infection. These state- 
ments have been selected from scientific works by such 
authorities as J. Whitridge Williams, M.D., Reuben Peter- 
son, A.B., M.D., E. Heinrich Kisch, M.D., Howard Kelley, 
A.B., M.D., LL.D., F.R.C.S., Barton Cooke Hirst, M.D., 
J. Clifton Edgar, M.D., Thomas Watts Eden, M.D., and 
Joseph E. De Lee, M.D. 

Division 3. Economic and Sociological Foundations 
Folio Collection of excerpts from technical works on eco- 
nomic and social problems by such authorities as Carver, 
Taussig, Seager and Seligman, Gillin, Henderson, Healy, 
Mangold, Popenoe and Johnson, Ross and Warner. 

Division 8. International Foundation 
Folio Collection of Material and Maps showing the famine 
conditions prevalent in various countries, with special 
reference to the outlook for maternal and child life of the 
future. 

Division 5. Human Foundation 

A. Folio Collection of Letters from Mothers selected as rep- 
resentative of 50,000 letters setting forth the overwhelm- 
ing health and economic problems that confront the fam- 
ilies of the middle and poorer classes in America today. 

B. Three large charts showing the reasons presented by 1250 
families for their adoption of the plan of limitation. These 
families are representative of the middle and poorer 
classes of our society, and the reasons assigned will be 
noted: — economic condition, health of mother, health of 
children, health of husband. 



8 INTRODUCTORY 

PART III. 

THE SCIENTIFIC CLINIC— THE GOAL OF THE BIRTH 

CONTROL MOVEMENT 

Division 1. 
History and Character of the Clinics of the World 
Folio Collection of material relative to Holland, Australia, 
New Zealand and England. 

Division 2. The Present Situation in America 
Folio Collection of material showing legal obstructions in 
America, Federal and State, their origin, operation and 
results. 

PART IV. 
AUTHORITATIVE OPINIONS UPON BIRTH CONTROL 

Folio Collection of statements of views of accepted authori- 
ties, Scientific, Medical, Economic, Sociological, Eccle- 
siastical, and Literary. 

PART V. 

Division 1. Special Exhibits 
Collection of photographs of various racial types of Mother- 
hood in America, and views of home conditions under 
which this maternity and infancy succumb to disease and 
squalor. 

Division 2 

A. A series of twenty-five large charts presenting inter- 
national vital statistics, prepared in England for the Con- 
ference. These charts are, it is believed, the latest pres- 
entation of the relation of birth and death-rate to net 
increase of population in those countries where vital sta- 
tistics are available. 

B. Chart showing birthrate in rich and poor quarters of four 
European cities. 

Two social events formed part of the programme of the First 
American Birth Control Conference. The first was a dinner 



BIRTH CONTROL V 

at the Hotel Plaza, given on Saturday evening, November 12th. 
Mrs. Juliet Barrett Rublee was toastmistress and the principal 
speakers were Mrs. Margaret Sanger and Mr. Harold Cox. In 
addition to these speeches there were greetings from several 
guests representing foreign countries, among them, China, 
Japan, and India. The dinner formed a brilliant winding up 
to the scientific sessions of the Conference, and a curious pre- 
lude to the unexpected police action of the following day. 

The other social event was a reception and tea on Sunday 
afternoon, November 13th, given to the delegates and guests 
of the Conference by Mrs. Ernest R. Adee, at her home at 
161 East 70th Street, New York City. 

—A. G. P. 

PROGRAMME 

FIRST AMERICAN BIRTH CONTROL CONFERENCE 

NOVEMBER 11th— 18th, 1921 

Sessions of the Conference 
Friday, November 11 
9:30 A.M. Registration of Delegates and Guests. 
10:00 A.M. Opening Session. 

Address of Welcome 

Edith Houghton Hooker, Chairman of the Sessions 

Opening Address 

Margaret Sanger, 

Chairman First American Birth Control Conference 

Presentation of Papers 

Dr. John C. Vaughan, New York City — "Birth Control Not 
Abortion." 

Dr. A. B. Wolfe, University of Texas, Austin, Texas — "Sources 
of Opposition to Birth Control." 

Dr. Reynold A. Spaeth, School of Hygiene and Public Health, 
Johns Hopkins University, Baltimore, Maryland — "Birth 
Control as a Public Health Measure." 

Dr. S. Adolphus Knopf, University of New York and Uni- 
versity of Paris, New York City — "Eugenics and Birth 



10 INTRODUCTORY 

Control in Their Relation to Tuberculosis and Other Med- 
ico-social Diseases.^' 

Dr. Alice Butler, Cleveland, Ohio — '^Individual Woman's 
Need of Birth Control." 

Dr. Frederick C. Heckel, New York City — ''Evil Results to 
Motherhood Through Lack of Birth Control Information." 

Dr. Lydia Allen DeVilbiss, Wshington, D. C. — "Medical 
Aspects of Birth Control." 

Dr. Abraham Myerson, 483 Beacon Street, Boston, Mass. — 
"The Inheritance of Mental Disease." 

Discussion. 

2:30 P.M. Presentation of Papers 

Dr. Aaron J. Rosanoff, Clinical Director, Kings Park State 

Hospital, Kings Park, Long Island, New York — "The 

Question of Birth Control Discussed from a Psychiatric 

Standpoint." 
Dr. Roswell H. Johnson, University of Pittsburgh, Pittsburgh, 

Pa. — "The Eugenic Aspect of Birth Control." 
Dr. C. C. Little, Carnegie Institution of Washington, Cold 

Spring Harbor, Long Island, N. Y. — "Order of Birth and 

the Sex Radio." 
Miss Virginia C. Young, 17 Beekman Place, Inc., New York 

City — "The Problem of the Delinquent Girl." 
Prof. E. C. Lindeman, North Carolina College for Women, 

Greensboro, North Carolina — "Birth Control and Rural 

Social Progress." 
Dr. Harriette A. Dilla, Smith College, Northampton, Mass. — 

"The Greater Freedom by Birth Control." 
Mr. J. 0. P. Bland, London, England — "The Population Ques- 
tion as Illustrated by Asia." 
Discussion. 
8:00 P.M. Private Session on Contraceptives for Members 

of the Medical Profession by invitation only. 

Dr. Lydia Allen DeVilbiss, Chairman. 

Saturday, November 12 
9:30 A.M. Presentation of Papers 



BIRTH CONTROL 11 

Dr. Lothrop Stoddard, Brookline, Mass. — "T^e Population 
Problem in Asia." 

Mr. James Maurer, President Pennsylvania Federation of La- 
bor, Harrisburg, Pa. — ''Birth Control and Infant Mor- 
tality: an Economic Problem." 

Mr. Harold Cox, London, England — "War and Population." 

Discussion. 

2:30 P.M. Presentation of Papers 

C. V. Drysdale, 0. B. E., D. Sc, F. R. S. E., London, England, 
President of the Malthusian League — "National Security 
and Peace" 

Dr. W. F. Robie, Baldwinville, Mass. — "Some Thoughts on 
the Medical Aspects of Birth Control." 

Dr. William J. Robinson, New York City — "Infanticide, Abor- 
tion and Birth Control, the Three Stages in the Limitation 
of Offspring and Control of Population." 

Mr. Andre Tridon, New York City — "Birth Control and Psy- 
cho-analysis." 

Professor Herman M. Bernelot Moens, Holland — "Dutch 
Opinions." 

Miss Mary Winsor, Haverford, Pa. — "The Birth Control Move- 
ment in Europe" 

Discussion. 

Reports and Resolution. 

Adjournment. 

7:30 P.M. Dinner— Hotel Plaza Ball Room. 

November 13 
5:00 P. M. Tea at the home of Mrs. Ernest R. Adee, 

161 East 70th Street, for Delegates and Guests. 
8:00 P.M. Public Mass Meeting, Town Hall. 

"BIRTH CONTROL— IS IT MORAL?" 

{Meeting held November 18th, Park Theatre, after raid on 

Town Hall by police.) 



12 INTRODUCTORY 

Special Exhibits 
Hotel Plaza, Room 134 
Pictorial Appeal for the Motherhood of America 

By Lewis W. Hine, New York City. 
Preliminary Exhibit showing Biological, Economic, Socio- 
logical Foundations of Birth Control. 
Harriette A. Dilla, Ph.D., L.L.B., Chairman of Exhibits. 

PROCEEDINGS 

SESSION I. 

FRIDAY, NOVEMBER 11, 1921 

Edith Houghton Hooker, Chairman 

OPENING ADDRESS 

THE CHAIRMAN: My friends, in the name of the Amer- 
ican Birth Control League I bid you welcome. In the 
name of common sense and humanity I bid you welcome as 
well. 

The time has come, I think, when Americans and the people 
of all the world must realize that the most important problem 
on earth is the problem of population. After all, it matters 
little what we do in after life if we are not born right in the 
beginning, and the purpose of this conference, as I take it, is 
to discuss ways and means of bringing reason into the realm 
of reproduction. 

All of us must agree that the most important institution in 
any community is monogamous marriage; that after all the 
home is the backbone of the state, and that unless the home is 
properly safeguarded by all rational means, we cannot hope 
to build as good a nation, or as good a world as we could if 
reason did dominate there. 

I think that as the background of monogamous marriage, 
Birth Control is an absolute essential. Because now we see 
homes upon homes broken up, wrecked and ruined as the 
result of unthoughtful reproduction. If we wish to build our 
nation right, we must first set our own homes in order, and 



BIRTH CONTROL 13 

the purpose of this conference is to begin at the beginning, and 
to set about the task in the right way. Until women feel this, 
until all of us feel this, there is little that can be done in this 
realm, because after all the problem does touch women even 
more closely than it does men. 

As we recall it, once upon a time we were in the same state 
as the woman who was called upon by a man living nearby to 
come over to help his wife, who was very ill. This man rushed 
in to the friend's house, to Mrs. Blank "Come and help me. 
My wife is ill and I need help." It was in the cold gray dawn, 
and Mrs. Blank arose and dressed herself with great speed, 
and hurried down, and as she passed through the entrance she 
stubbed her toe and fell. The man turned to her in despair and 
said "Hurry. Come on, don't wait till you get up." 

In the days gone by that was precisely the predicament 
women were in. They could not get up, so to speak. They 
were not asked. They had no power. And although they 
might have had the right idea, they could not put the idea into 
effect. But now with woman suffrage in effect, it may be 
possible to straighten out some of the legislation that has gone 
before, and to bring some sort of order out of chaos, into this 
most difficult sphere. 

The purpose of this conference is, I take it, two-fold: First, 
to bring together the common-sense people who can be reached 
and to take definite action with regard to our future course. 
And, secondly, to serve as a nucleus of publicity so that the 
light may go into the darkness, and many people who had 
heretofore been wholly in ignorance of the possibility even of 
Birth Control may see the light and gain new courage. 

I wish here to commend the courage of those who have come 
to attend this conference. Because, it does take a certain 
amount of courage to come out for a new cause, and in America 
Birth Control is in that category. Courage is the first essential, 
I take it, in all forward looking movements, and it is well for 
us to realize that without courage it is impossible to make 
progress. If we merely sat still and accepted the dictates of 
our confederates, if we merely stood in one spot and had not 



14 FIRST SESSION 

the courage to go forward, we would never achieve much in 
this world. 

I have now to introduce to you a woman who has shown 
courage, who has realized that the most important thing in the 
world was to go forward constantly, to work against that 
monster, prejudice, which everywhere blocks the road to prog- 
ress, and who has had the vision to see that America must 
become enlightened, must come to realize that the children of 
the future are the important asset in this nation and that they 
must be safeguarded from the very commencement — a woman 
who has realized that the most important thing in any nation 
is its little ones, such a woman is the one whom I no\< 
introduce to you, Mrs. Margaret Sanger. 

Margaret Sanger 

1AM glad to join in the welcome that Mrs. Hooker has 
given you. I cannot tell you how much this conference 
means to me. I cannot tell you how long I have looked for- 
ward to it — how long I have hoped that the great day might 
come wheni intelligent, representative American jnien and 
women might gather together to discuss our great problem. 
The fact that you are here is enough to show me that intelli- 
gent interest is now awake, and that along with it come hope 
and courage and determination. Our conference has aroused 
far more wide-spread interest than we had dared to expect. 
Our work in organizing it has shown, as nothing else could, 
that our years of agitation and fighting — thankless, discour- 
aging, endless battling against prejudice and hypocrisy — have 
made their impression. I cannot tell you with what enthusiasm 
we have all been inspired by the letters and answers we re- 
ceived while getting up the Conference. I cannot tell you 
how much I appreciate the sympathy and assistance of all 
those of you who are here, and of the thousands of others 
who have written us and encouraged us to go ahead with this 
great work. 

The idea in calling this Conference was to bring together 
not our old friends, the advocates of Birth Control, whose 



BIRTH CONTROL 15 

worth we know and whose courage has stood the test of oppo- 
sition; but rather to bring together new people, with other 
ideas, the people who have been working in social agencies 
and in other groups for the same results as we, namely a better 
nation and the banishment of disease, misery, poverty, delin- 
quency and crime. The time has come to cease propagating 
these evils, if our civilization is to survive. Everywhere we 
are confronted by the fact that poverty and large families go 
hand in hand. We see the healthy and fit elements of the 
nation carrying the burden of the unfit who are increasing in 
numbers — an increase which threatens to wipe out the fit and 
healthy population of our land. 

And so we rejoice to have, here, you who are representing 
other social activities, health agencies, and we hope that you 
will give us new ideas, as we hope that you will also find 
inspiration here to help you to further your own work, your 
own cause. Let us try to make this a true conference. It is 
your duty to confer. All of us who have come here, some of 
you from great distances, are animated by intense and active 
interest. I believe that the most valuable phase of our all-too- 
brief meetings will be the discussion of the papers. Brief as 
the discussion must be, much can be said in a few words. We 
have therefore decided not to present all the papers sent us, 
but to select those most suggestive, those that throw new light 
on problems interrelated with Birth Control. 

We are in a condition of society today, not only here, but 
practically in every country of the world, where the masses 
of the unfit have propagated to such an extent that our in- 
telligence is not able to grasp or cope with the conditions so 
created. We have been putting the energy and efforts of our 
healthy and fit into bricks and mortar. We have erected pala- 
tial residences for the unfit, for the insane, for the feeble- 
minded, — for those who should never have been born, to say 
nothing of their being permitted to carry on the next generation. 
Now the time has come when we must all join together in stop- 
ping at its source misery, ignorance, delinquency and crime. 
This is the program of the Birth Control movement. This 



16 FIRST SESSION 

is what the Birth Control advocates intend to do — ^to stop at its 
source those processes which are making for a weakened and 
deteriorated race. 

There are two instincts which have ever guided the destiny 
of mankind. These instincts are hunger and sex. The instinct 
of hunger has received consideration in practically every civ- 
ilized country and man has adapted his institutions to meet 
its needs. But the instinct of sex has been ignored. Now I 
claim, and most of us who make a study of the subject know, 
that this instinct is just as deep, just as fundamental, as the 
instinct of hunger. It cannot be crushed. It cannot be denied. 
But we must understand it. We will then utilize it, as we 
utilize music and prayer for our highest powers and for 
higher illumination. 

The question that confronts us is: "Is it desirable that man 
shall control this instinct?" Is it desirable that this instinct 
be satisfied without increasing the population of the world? 
Will mankind be benefited by obtaining control over this in- 
stinct? And is it desirable that in satisfying it, we shall de- 
cide whether offspring be the result or not? A further ques- 
tion is: Is it desirable that the unhealthy, the unfit, the feeble 
members of the community propagate their kind and fill the 
world with their children? Is it right for these to populate 
the world, as has been done, or shall some stringent measure 
be taken to stop this if we are to survive? After discussing 
these questions, the next question to be discussed will be the 
possibility of bringing about the results that we desire. We 
all know that knowledge is power. Man has a right to all 
knowledge. Ignorance is not a virtue, nor is it a safeguard 
against immorality. If there is knowledge which enables man 
to control birth, then it is right that he should have this 
knowledge and should be able to obtain that result. 

This conference will discuss these two subjects. We must 
first establish the principle of the right to Birth Control. We 
must encourage the acceptance of this principle by other 
agencies and organizations, and the inclusion of it in their 



BIRTH CONTROL 17 

programs for peace, for social betterment and for a better 
world. 

The idea of Birth Control is not new. It has been advocated 
from almost the very earliest history of man. We know that 
Plato and Aristotle advocated it. It has been advocated by 
practically all the greatest philosophers and thinkers of all 
times. But the idea in the past of limiting their numbers was 
a little different from that of today. The methods employed 
in the past were mainly infanticide, and abortion; while today 
we desire to prevent conception. This new idea is making 
headway in practically every country in the world. The 
Birth Control movement in the United States has been the 
greatest instrument for spreading this idea, this modern sci- 
entific idea. Already we have groups in China, in India, in 
Mexico, in South America, to say nothing of groups in Ger- 
many, England, Scandinavian countries, Italy, Russia and 
Hungary. This new idea is taking its place in the social body, 
and I think we can say that America has recently been the 
leading country in this new idea of Birth Control. 

This is the first Birth Control Conference ever held in this 
country, and we have a very elaborate program, and our aims, 
as we understand them, are based upon scientific principles. 
We intend to organize the thinking population of this country. 
We intend to have active groups in every city. We know that 
while people have privately believed in Birth Control, and have 
agreed with us in their own minds, they have not had the cour- 
age to come out and speak or work for the principle, and the 
time has come when this must be changed. The time has come 
when the intelligent members of the community must come 
forth and work with us in making this a national program. 
We want to have the restrictive laws both federal and state 
repealed. And we stand very definitely on the demand that 
Medical Profession shall give this information. We stand 
definitely on the principle that this question of giving infor- 
mation is not a question of free speech, but it is a question of 
scientific technical knowledge. We want the medical pro- 
fession to give to women the most scientific advice obtainable. 



18 FIRST SESSION 

It was only a few years ago, you know, that obstetrics was 
considered unimportant enough for any woman to take care 
of. A woman giving birth to a child was left to her neighbor 
to come in and deliver her. The medical profession did not 
consider the matter dignified enough for them to look after. 
Until now, the same thing has been true of contraception, and 
we are going to make the control of birth a scientific subject. 
We are going to put it into the dignified field of science where 
it belongs. 

Our definite aim is to repeal the laws so that the medical 
profession may give to women at their request knowledge to 
prevent conception. We believe that with the assistance of 
the intelligent members of the community we can bring this 
about in a very short time, but we need your help. We need 
your courage. We need you to come out and stand with us 
on our platform. We also want your guidance, your assist- 
ance, your suggestions. None of us think that we know it all. 
We know that you, in your special lines, have experience by 
which we can benefit, and we want your cooperation. In other 
words we want to join together to make this country the 
greatest country in the world. We want to make this a country 
where every member of the community is an independent, self- 
reliant, courageous individual who will take his place in the 
nation, and the nation in its turn will take its place in the 
forefront of the nations of the civilized world. 

BIRTH CONTROL NOT ABORTION 
By Dr. John C. Vaughan, New York 

MADAM CHAIRMAN and Fellow Workers: 
Various estimates, made by those entitled to know, 
place the number of abortions performed each year in the 
United States at from 500,000 to 3,000,000. This wide range 
in numbers is due partly to the difficulty in gathering statis- 
tics and partly to the difference in opinion as to what should 
be classified as abortion. I feel therefore that we should use 
an arbitrary and exact definition of abortion, one allowing no 



BIRTH CONTROL 19 

chance of misunderstanding or side-stepping, one so clearcut 
at both ends that our foes, as well as our friends, will know 
exactly what we mean when we use the word "abortion." To 
me abortion means the termination of the intra-uterine devel- 
opment of a fertilized ovum, and, using the word as so defined, 
I would like to have the following statement introduced as a 
permanent plank in our platform: 

The bringing about of an abortion should 
never be necessary; can never be moral; and 
must rarely be legal. 

I am aware that to reach the level represented by such a plank 
a great deal of educational work will be needed — for the male, 
as well as for the female; more frequent and careful exam- 
inations must be made of possible and prospective mothers, 
and more control and understanding must be taught to the 
fathers. 

With this understanding of the term abortion, it should be 
easy to explain the difference between abortion and prevention 
of conception; but before going into this I will briefly state 
a few general facts regarding human reproduction, which it is 
necessary to keep in mind. These facts are: — First, Each girl 
baby at birth has in her ovaries roughly 50,000 cells of a 
certain type. These cells are the direct offspring of the fertil- 
ized ovum from which she grew and are therefore the direct 
descendants of her male and female parents. Her relation to 
them is merely that of a host. They receive nothing from her 
during their life except environment. At puberty these cells 
commence to be thrown off at the rate of one a month. One 
of these cells, fertilized, is capable of developing into an in- 
dividual. Hence each woman warehouses the possibilities of 
50,000 new human beings within her at the time she reaches 
puberty. Yet how few of these can she bring into actual ex- 
istence even under the most favorable circumstances! 

The male germ cells, on the other hand, are multiplying all 
the time in countless millions, and as only one male cell can 
enter the ovum on fertilization, we see that whereas not more 



20 FIRST SESSION 

than one female cell in 5000 has any chance of developing into 
a human being, of the male cells only one in many millions 
has the possibility of so developing. Therefore, if for any 
reason we find it advisable to keep apart the male and female 
elements, we are only doing on a very small scale for the 
betterment of the human animal what nature is constantly 
doing in the most lavish manner. It can also be seen that 
these cells, both male and female, which are kept apart, are 
incapable of developing into human beings. Unfertilized they 
are no more worthy of consideration than the many cells shed 
from our skin each day; than the cells lost in menstruation, 
or those composing the hair which we shed or cut away. 

I see no reason why the interposition of some moral, 
chemical, or mechanical means to keep the male element away 
from the female element can be considered immoral, nor why 
such an interposition should be made illegal. Any means used 
to keep the male and female elements from uniting is a pre- 
ventative or contraceptive. But when once fertilization has 
taken place, then all the possibilities of a new soul, a new 
individual, are opened up, and an individual life is started 
that should be covered by the same protective laws that cover 
all human beings. The same laws that protect adults protect 
children. It is no less a crime to kill a baby than it is to kill 
an adult. Why should it be any less a crime, why should it 
be more moral or legal to destroy a life in its intra-uterine 
stages than it is after these stages are over and the baby has 
been born? And I say again that from the time the ovum is 
fertilized until the infant passes out of the uterus any destruc- 
tive interference with it must be considered abortion, and that 
abortion should never be necessary, can never be moral, and 
must rarely be legal. 

It can readily be seen that the definition we have adopted 
brings within the classification of abortion the many cases of 
so-called delayed menstruation that are brought about by ma- 
nipulation, medication or some one of the common devices so 
well known to those in the medical profession. 

Time does not allow me to enter into the discussion as to 



BIRTH CONTROL 21 

whether it is more or less moral, or whether it should be more 
or less illegal to destroy an individual pre-natally, or to de- 
stroy it after birth by allowing it to come into a world where it 
cannot have the freedom of mind and body that alone can 
develop a soul. But I will take time to state that as long as 
children, brought into the world, are throttled by poverty, 
racked by inherited insanity, snuffed out by inherited diseases, 
wasted by wars and by our social system, thoughtful mothers 
choose abortion, when they feel it necessary, unless they are 
given some better alternative. 

No one can doubt that it is better to prevent crime and im- 
morality than it is to attempt to cure the criminal, and as 
abortions have steadily increased regardless of the fear of 
death and of threats of punishment, both legal and religious, 
I maintain that there is only one safe and scientific way in 
which to handle the situation, and that is to prevent abortion 
from being necessary. Therefore I demand that we be given 
the right to instruct those who find it necessary for any reason 
to refrain temporarily or permanently from having children 
and that we be given freedom and help in order that we may 
find the best methods of prevention of conception. 

SOME SOURCES OF SENTIMENT AGAINST 
BIRTH CONTROL 

By Dr, A. B. Wolfe, Dept. of Economics and Sociology, 
University of Texas 

THE Dallas News for October 14, 1921, printed a half- 
column editorial upon the report that the Disarmament 
Conference would be asked to consider Birth Control as a 
means of lessening the chances of war. "As a serious pro- 
posal," the News said, "that may be a joke . . . The proposal 
is too unlikely of serious consideration for anybody to get 
serious about it." Hinting broadly that Birth Control advo- 
cates are fools, the editorial goes on to class the Malthusian 
theory as a conception of "pseudo sociology," and concludes 
that "it would be as well to regulate the imagination or 



22 FIRST SESSION 

arbitrate the moon" as to discuss population limitation at a 
Disarmament Conference. 

Such exhibition of flippant ignorance and inherited prejudice 
are common enough in the press. Their high frequency rate 
suggests that the Birth Control movement will do well to 
analyze carefully the sources of sentiment opposed to it, in 
order to deal with them more effectively. 

Only a few of the major sources can be touched upon in 
the present paper, but these few are deeply rooted in insti- 
tutional history, and both authoritatively powerful and subtlely 
influential in perpetuating those vast and inscrutable under- 
currents of conservative and dogmatic prejudice which every 
progressive movement has to battle against. 

Sentiment against Birth Control is in large part derivative 
from a century old prejudice against the Malthusian theory of 
population. Malthus' Essay was first published in 1798 as a 
polemic against communism. In this first edition, Malthus 
recognized only two checks to the overgrowth of population — 
the positive checks, war, famine and misery, and the preventive 
check, which boiled down essentially to "vice." This exceed- 
ingly cynical view was stated in hard and fast terms. Pro- 
viding it were true, it was an unanswerable argument against 
communism; but if it were true, it was also by implication 
something of an indictment against the Deity, whom the 
theology of the time regarded as omniscient, omnipotent, and 
all-merciful. Malthus felt this horn of the dilemma and tried 
to get off by explaining it away on weak metaphysical grounds. 

Practically the entire English clergy rose up and smote him 
for publishing a blasphemous and sacriligious book. It was 
clear to them that God would not send new mouths without 
hands and food to feed them. To assert that starvation and 
vice are part of the order of nature, which is that of God, was a 
heinous business. 

In the second edition, 1803, Malthus introduced his "moral 
restraint" check — a preventive check not classifiable as vice, 
and one to which it would seem the most exacting moralist 
could not object. But the logical loophole offered by moral 



BIRTH CONTROL 23 

restraint got scant attention, partly because the clergy never 
had questioned that the Genesis command to increase and mul- 
tiply was an injunction still obligatory, and partly because 
few of them read the book. Perhaps, too, they were in a position 
to have some unexpressed doubts as to the effective reality of 
moral restraint. 

Anyhow, the sentiment of the church, both Protestant and 
Catholic, from that day to this has been strongly against the 
idea of the possibility of over-population and bitterly against 
any artificial limitation of offspring. 

The landed gentry and the business interests, however, hailed 
Malthus as a Daniel come to judgment. They wanted low 
wages, and here was a man who justified this desire by showing 
that payment of anything more than subsistence wages was 
useless because the excess would simply result in more chil- 
dren and continued poverty. Naturally the growing hand of 
humanitarians pushing for child labor laws and adequate pub- 
lic relief of the poor did not take kindly to any such doctrine. 
So another train of sentiment against "Malthusianism" was 
started. 

In America, naturally, no one could take Malthus seriously. 
We were thirteen miserable little colonies strung out on the 
Atlantic Coast, with a vast hinterland of those "unbounded 
natural resources," in the capacity of which to support a limit- 
less population the patriotic American has scarcely yet ceased 
to believe. As late as the 1880's, the professor of moral phil- 
osophy at Harvard, motivated by a combination of "un- 
bounded" Americanism and theological postulates, wrote a 
long condemnatory essay on "Malthusianism, Darwinism, and 
Pessimism." Pride of growth has been an American trait. 
Anything which questioned the rationality of that pride has 
been resented. There will be few real estate agents members 
of the Birth Control League. 

These historical influences, set out here in perhaps some- 
what too definite relief, sentiments not sharply focussed nor 
pointed directly against the Birth Control movement, of which 
the great masses are but dimly, if all conscious, constitute, 1 



24 FIRST SESSION 

believe, one of the greatest impediments to the early adoption 
of a rational population policy. 

Other sources and centers of sentiment, more definite, and 
consciously aimed directly against Birth Control, exist, how- 
ever, and are equally powerful. 

The most obvious of these is the church, with its inherited 
prejudice against anything bearing any relation to Malthus. 
Historically considered, the moral code of the church is non- 
pragmatic, and based on precedent and authority. Generally 
speaking, its methods of debate and reasoning have been non- 
inductive, dogmatic, and doctrinaire, not to say at times 
casuistic and supremely oblivious to facts. 

The conservative view of the church, more or less sharply 
and authoritatively formulated in the church disciplines, is 
that all mechanical (some say all) contra-conceptual means of 
limitation are "unnatural," and hence immoral and sinful. 

Compelled to compromise with the logic of facts and with 
advancing knowledge and reason, the church now seems will- 
ing to grant the "moral restraint" of the sacrilegious Malthus 
as a permissible mode of limitation. Malthus himself never 
hoped for too much from this check, and the modern clergy 
betray similar doubts when they intimate the heavy demand it 
puts on human character, when they go on to argue that be- 
cause "a moral duty is difficult is no reason for setting it 
aside."* They confess the doctrinaire and impractical qual- 
ity of their code, for they know, or ought to know, that such a 
"duty" is, and will continue to be, set aside by all save a neg- 
ligible handful of the most "spiritual" faithful. Surely, noth- 
ing can be more illogical, or in the end less moral, than to 
insist, in the face of demonstrated tragical misery, injustice, 
and sex slavery, and of the literally awful economic and 
political results sure to flow from indefinitely continued popu- 
lation increase, upon a moral precept, however sound in the 
abstract, which ninety-nine per cent of the population will 
ignore. 

Ecclesiastical argument as to "natural" and "unnatural" con- 



♦English Birth Rate Comniiseion, Problems of Populafion and Parenthood, 1920, p. xlviL 



BIRTH CONTROL 25 

duct exhibits a curiosity of clerical logic which would be 
comical if it were not so tragically dangerous in its possible 
effect. 

According to clerical reasoning, it is "natural" to use the 
reason to avoid unneeded and unwanted children, provided the 
method involve denial to the instinctive physico-spiritual func- 
tioning of conjugal love. (Parenthetically one must in charity 
observe that the clergy are deplorably ignorant of psycho- 
pathology.) 

But the moment the reason finds simple, harmless ways of 
limiting the birth rate without incurring the neuropathological 
strain incident to the thwarting of the most powerful and funda- 
mental natural instinct, the reason becomes "unnatural." The 
sex instinct is natural, the desire for children is natural, the 
desire not to have more children than can be given a fair start 
in life is natural, possibly the desire to avoid international 
piracy and war is natural, the furthering of these desires by 
moral restraint is rational and natural, but to use the reason 
to further them by simple contra-ceptual means, harmless to 
health and costless in point of nervous strain, is "unnatural." 
The distinction is a fine one and I confess my logical vision is 
not microscopic enough to see it. Yet upon it is based a vast 
amount of authoritatively inspired sentiment against Birth 
Control. Thus millions of unwanted babies are born, thou- 
sands of women are made involuntary mothers, and a future 
heritage of international conflict is laid on the world, all to 
justify a piece of scholastic dialectics. 

If ecclesiasticism, with its male-made morals and logic, con- 
stitutes one very definite center of dogmatic sentiment against 
Birth Control, two other equally powerful, though less frank, 
and perhaps less effectively organized agencies of opposition, 
lie in nationalism and commercialism. 

Historically, nationalism and mercantilism developed con- 
comitantly. Frederick the Great averred that the people are 
like a herd of deer in the park of a great nobleman; they have 
no other function than to multiply and fill the enclosure! We 



26 FIRST SESSION 

do not put the matter quite so bluntly today. The English 
Birth-Rate Commission says: 

"It might be thought that Great Britain might be a more 
comfortable place to live in [with less population] . . . 
But in the event of a war similar to that which we have just 
experienced . . . what would happen to our Empire. . . . 
Unless we add to our numbers, for how long shall we be able 
to fulfill our obligations in the face of recent developments 
of race ambitions? [in India and Egypt?] . . . The greatness 
of an Empire consists not in the heaping up of wealth, or 
even in the establishment of universal comfort, but in the 
possession of multitudes of healthy men and women who will 
enable it to maintain its position and influence among the 
nations."* 

If this means anything, it means that the state is end and the 
individual mere means, and that national greatness is measured 
by capacity to whip an adversary, or chastise recalcitrant 
dependencies, and lies in size and power, not in the happiness 
of citizens. The words are different, but the tune is that of 
Frederick the Great. Its modern title is "A Place in the Sun." 
We need not dwell upon the militaristic "race-suicide" dia- 
tribes of the late Theodore Roosevelt, or the extreme solicitude 
of the nationalists and militarists behind the French Re- 
population Commission to raise the French birth rate. Their 
thought dwells not on how to raise the French standard of 
living, nor on how to attain peace and good will, but only on 
preparation to lick Germany again. Similar canvassing of 
vital statistics, with similar ends in view, occupies many a 
mind in Germany. 

The simple fact is that militant nationalists, from Julius 
Caesar on, have always insisted on encouraging unlimited mul- 
tiplication, usually of course, for "defensive" purposes only. 
If you desire an honest analysis of population growth as an 
excuse for territorial aggression, read the first few pages of 
Plato's Republic, penned some 2300 years ago. 

The military demand for large populations involves any 



•Problems of Population and Parenthood, 1920, pp. Ixxvi. 



BIRTH CONTROL 27 

people that listens to it in a vicious circle. We must breed 
like rats to defend ourselves from other people who are breed- 
ing likewise to defend themselves against us. The more people 
we breed, the more land we must have. Hence to keep up our 
defensive program, we must attack some other people and 
take part of their territory. Such was the logic of Germany; 
such, apparently, is that of Japan, such must be the outcome of 
the philosophy of size and power everywhere. A more im- 
moral and a more futile conception of the function and value 
of national life I cannot conceive. 

The vicious circle of militaristic nationalism is paralleled 
by another in the logic of nationalistic commercialism. Em- 
ployers everywhere, under a system which, in spite of the al- 
most universal presence of monopoly and price fixing agree- 
ments, still retains some elements of competition, naturally 
prefer cheap labor to dear. The situation is more favorable 
to them when there are more workers than there are jobs. 
When there are more jobs than job hunters, wages go up 
and profits and interest tend to go down. Consequently, em- 
ployers have ground for desiring a redundant laboring popu- 
lation. Competition for foreign markets intensifies the desire 
for cheap labor. The usual argument is that we cannot secure 
and retain foreign markets without a plentiful supply of cheap 
labor at home. A large labor supply depends upon multi- 
plication. Hence, other things equal, that country is in the 
best situation with regard to foreign commercial competition 
which has the largest population. 

Now see where this lands us. We have to have cheap labor 
to secure and retain foreign markets. Hence, we must not 
limit our multiplication. Then, presto change, comes the 
reason why we must push out for foreign markets. We must 
have these foreign markets to keep our great population em- 
ployed. 

Just here comes the rub — and incidentally the close relations 
between the business interests and the foreign ofl&ces. For 
other nations besides ourselves have to have these same foreign 
markets to keep their huge populations employed. Friction 



28 FIRST SESSION 

and conflict are bound to ensue. Hence the commercial as 
well as the patriotic value of military power, the basis of 
which is numbers. 

Thus we are involved in two interlacing vicious circles, the 
logic of one of which is traceable to Chauvinistic nationalism, 
that of the other to special economic interests which greatly in- 
fluence, if they do not absolutely control, governmental policy 
and public sentiment. 

It is not to be supposed that business men will argue as 
frankly as this against population restriction, but military men 
will, and do ; and the business interests tacitly take the position 
indicated. That precious triumvirate, the short sighted, profit- 
seeking business man, the secret diplomatist, and the flag- 
waving munitions manufacturer, will not be slow to classify 
all Birth Control advocates as foolish fanatics and dangerous 
"radicals." 

Birth Control is not a mere matter of diJBference between 
conservative and progressive sentiment, nor of closet phil- 
osophy. The population problem is a matter of the life or 
death of civilization. The whole world is astoundingly igno- 
rant of the fact that at our present rate of population growth — 
a doubling in the past century, 1.16 per cent annually just 
before the war,* we are headed toward unspeakable things. 
Assuming an increase of 1 per cent annually, the world's pop- 
ulation, now approximately 1,700,000,000, would be in 1970 
2,796,000,000, in 2021 4,598,000,000, and in another hundred 
years 12,437,000,000.t If anyone believes that the present 
rate of increase can be maintained without involving the world 
in chronic famine and war, he has a better imagination that I 
can lay claim to. 

In a remarkable series of studies. Professor Raymond Pearl, 
of Johns Hopkins University, has shown by mathematical and 
statistical analysis that the upper limit of population in the 



♦G. H. Knibbs, The ProblemB of Population, Food Supply and Migration, ScientJ4i, 
Vol. xxvi, 1919, p. 485. 
tibid, p. 486. 



BIRTH CONTROL 29 

United States, at anything like our present standard of living 
is below 200,000,0004 

At the present rate of growth we shall reach that point in a 
few decades. What then? Breed to kill and kill to breed? 

It would seem, after all, the leading metropolitan daily of 
the Southwest to the contrary notwithstanding, that Birth Con- 
trol is a matter to which the Disarmament Conference might 
with benefit to the future prospects of civilization, devote some 
slight attention. 

BIRTH CONTROL AS A PUBLIC HEALTH MEASURE 
By Reynold A, Spaeth, Ph. D, 

(School of Hygiene and Public Health, Johns Hopkins University, 
Baltimore, Maryland) 

IN DISCUSSING Birth Control as a public health measure 
we deliberately exclude for the moment such questions 
as morality, religion, and economics — including the matter of 
war and peace. Each of these questions is vital to public 
health in a specific and important way and the discussion of 
each is bound up with the consideration of Birth Control. But 
they are not within the province of the physiologist concerned 
directly with particular problems of public health. In the 
School of Hygiene and Public Health of the Johns Hopkins 
University, we are particularly striving for the assured health 
of the community; with the prevention rather than the cure of 
disease; with the causes that make for infant mortality, epi- 
demics, industrial diseases. We offer courses and engage in 
research in every branch of scientific knowledge that throws 
light on the causes of ill health, — the dangers of improper 
home and industrial environments and the best ways of com- 
bating disease at is source and preventing its spread. 

The public health viewpoint is essentially non-partisan. It 
would be obviously unpractical to apply sanitary measures 

JR. Pearl and L. J. Reed, On the Rate of GrowPh of the Population of the United 
States since 1790 and its raathemaical representation, Proceedings of the National 
Academy of Science, Vol. 6, 1920, pp. 275-288; R. Pearl, The biology of death, Scientific 
Monthly, September 1921, pp. 193-213. Sec also two able articles by Prof. E. M. East 
of Harvard University: Population, Scientific Monthly, June 1920, pp. 603-624, and The 
Agricultural limits of our population, Scientific Monthly, June 1921, pp. 551-557. 



30 FIRST SESSION 

exclusively in the homes of the wealthy and educated. But 
public health is concerned not only with the prevention and 
control of disease, but ultimately with every factor which con- 
tributes to the health of individuals in all walks of life. 

We must admit that by limiting the number of their ofif- 
spring both the health and happiness of the well-to-do are 
frequently increased. If we could prove that this practice 
was on the whole injurious among the educated and wealthy, 
we might make out a case against the further dissemination 
of contraceptive information. The advantages, however, espe- 
cially in the twenty-five hundred to seven thousand dollar 
groups, which include the vast majority of university men and 
women, are many and obvious — we need only recall the higher 
standard of living, the proportionately greater attention re- 
ceived by each child in the small family and the better health 
of the parents — that in my opinion public health authorities 
must see the urgency and wisdom of extending these advan- 
tages to individuals on more modest intellectual and economic 
levels. 

In order to meet the terrifying economic combination of a 
large family and a small income, the wives of industrial 
workers frequently themselves enter industry. Under these cir- 
cumstances a pregnancy is peculiarly demoralizing. Industry 
has no particular place for the expectant mother, nor, it must 
be admitted, has the pregnant woman any particular contribu- 
tion to make to industry. Even though a good worker, she is 
at best an unstable asset, for no method of job analysis or 
scientific management, has thus far succeeded in establishing 
any guiding principle for her behavior. We know that her 
metabolism is profoundly changed and that she frequently 
shows an abnormal sensitivity to fatigue. The latter is cer- 
tainly not diminished by the realization of the additional phys- 
ical and economic burden about to fall upon her shoulders. 

At this point, the problem of hyper-fecundity may become 
directly associated with that of venereal disease. In their 
dread of further pregnancies, women, both in industrial and 



BIRTH CONTROL 31 

non-industrial life, frequently feel compelled to wink at extra- 
marital sexual relations on the part of their husbands. 

Psychiatrists are familiar with the profound psychopathic 
disturbances that often result from the conflict between fear of 
pregnancy and the desire to maintain the marital relation 
intact. Here the problem reaches out into the great field of 
mental hygiene, a field in which intelligent doctors of public 
health are required to have more than a casual knowledge. 

Physicians frequently claim that contraceptive knowledge is 
widespread among even the poorest families. The difficulty 
is that such families fail to take practical advantage of their 
knowledge. What they really lack is sufficient imagination to 
appreciate the grave economic consequences to their immediate 
family that will result from the birth of an additional child. 

This point is probably well taken. No sane advocate of 
Birth Control as a public health measure believes that the 
population problem will be solved by distributing contra- 
ceptive information, even under the most favorable circum- 
stances and to the most needy. But that at least is an initial 
step. A long campaign of education and enlightenment in 
matters of economic and social values and responsibilities must 
follow. In this campaign for sanity and self-consciousness, 
public health officials must play an active part. 

BIRTH CONTROL IN ITS RELATION TO DISEASE 

By Dr. S. Adolphus Knopf 

University of New York 

Author of "A History of the National Tuberculosis Association.** 

(Extracts. Introduction, consisting of an analysis of conditions attend- 
ing the prevalence and spread of tuberculosis, omitted for lack of space.) 

THERE are also a number of useful citizens, men and 
women who are slightly affected with tuberculosis, know- 
ingly or unknowingly, and whose tuberculous condition can 
only be detected by a most careful examination. They may 
marry after their recovery, which is reasonably sure to take 
place if timely and properly treated. However, a predisposed 



32 FIRST SESSION 

woman should never marry a man who has the above described 
habitus phthisicus, and vice versa. When two individuals 
whose physique indicates a tuberculous tendency marry, their 
offspring rarely escapes the tuberculous disease. A single 
pregnancy in the woman predisposed to tuberculosis does not 
necessarily mean a development or aggravation of her con- 
dition, or a tuberculous infant, especially when the father is 
strong and vigorous, providing of course the mother has 
proper hygienic and dietetic care for a sufficient time prior, 
during and after confinement. On the other hand, frequent 
pregnancies, following each other in rapid succession, will 
surely undermine the mother's health, aggravate a predispo- 
sition or an existing slightly tuberculous condition, and will 
most likely bring into the world feebly and strongly pre- 
disposed children. 

All this means that the solution of the tuberculosis problem 
is not possible without judicious, humane, and scientific birth 
control. Only healthy parents can procreate healthy children. 
When the children are too numerous so that most of them, 
and particularly the latter born, had no chance to develop 
into mentally and physically strong men and women, they 
in turn will have children frail and subject to disease. 

In an admirable address entitled "The True Aristocracy," 
contributed to the recent Eugenics Congress, my esteemed 
friend, the distinguished Vice-Chancellor of the University 
of Liverpool, Prof. J. George Adami, very justly says that 
under modern conditions through the larger families of the 
unfit, the race is deteriorating and not improving. He suggests 
a selective mating among the physically, mentally and morally 
sound.* I have taken a careful history of many cases of 
tuberculosis covering a period of 25 years, and this has re- 
vealed to me that with surprising regularity the tuberculous 
individual, when he or she comes from a large family, is 
one of the latter born children — the fifth, sixth, seventh, eighth, 
ninth, etc. The healthiest children, as a rule, are those of 
young people who married at a comparatively early age. Eugen- 



''Scicntific Monrtily, November, 1921. 



BIRTH CONTROL 33 

ics has amply proven this and here again birth control enters 
as a factor. Young people, strong and vigorous, would gladly 
enter wedlock if they would know that it was within their 
power to have only as many children as they could well provide 
for. 

At the time of the marriage, the minister or magistrate 
who conducts this sacred act, or better yet, the official who 
issues the license, should hand to the couple a carefully pre- 
pared pamphlet containing instructions in parenthood and 
the duties and obligations this involves. Of course, no li- 
cense for marriage should be issued except to such as have 
been found physically and mentally fit to become the fathers 
and mothers of the future generations. Individuals physi- 
cally below par should be advised to delay marriage, and if 
that seems not feasible, they should be advised to delay having 
children until both, husband and wife, are physically in fit 
condition. 

It is not necessary here to go into the details of the many 
moral advantages of early marriages, such as the diminution 
of prostitution and venereal diseases. Even in our well-to-do 
and healthy families, considered our best American stock, and 
where larger families would be no burden, early marriages 
are unfortunately not encouraged. The opponents of birth 
control love to dwell on the theme of so-called race suicide. 
If this is applicable, it should only be spoken of in such 
instances where health, wealth and culture abound and still 
family limitation is practiced to a very appreciable and de- 
plorable degree. Birth control in cases of a distinctly tuber- 
culous father or mother, among the poor and underfed, is not 
race suicide but race preservation. 

We lose in this country about 50,000 children annually from 
tuberculosis. What heartache and suffering the births and the 
deaths of these 50,000 little ones, in many instances even un- 
welcome, have caused to the parents is difficult to conceive. 
There are overwhelming statistics to be found everywhere, 
showing conclusively that the larger the family, and particu- 
larly among those in moderate or poor circumstances, the 



34 FIRST SESSION 

greater is the death rate among the children. As to the eco- 
nomic loss which the commonwealth sustains from bringing 
into this world thousands of children mentally and physically 
crippled, I will confine myself to tuberculosis alone where 
we have been able to calculate, at least approximately, what 
this unthinking procreation costs. I stated above that 50,000 
children die annually from tuberculosis in the United States; 
figuring the average length of life of these children to be 
seven and one-half years and their cost to the community as 
only $200 per annum, represents a loss of $75,000,000. Such 
children have died without having been able to give any 
return to their parents or to the community. Who will dare to 
calculate in dollars and cents the loss which has accrued to 
the community because so many mothers died of tuberculosis 
when an avoidable pregnancy was added to a slight tubercu- 
lous ailment in a curable stage. 

As eugenists we are interested in the possible results of 
birth control. Should our laws become more tolerant in this 
respect? S(hould birth control clinics become a general 
feature as they have been in Holland and are now in England? 
Should these clinics function not only to help the poor and 
sick woman to prevent too frequent pregnancies but also to 
help the healthy, childless wife who longs for offspring but 
hesitates to seek or cannot afford to pay for private expert ad- 
vice, to have her often curable sterility overcome? If our 
government should be willing to spend as much money, or 
even a good deal less, for the study of the best possible and 
most careful means of preventing conception, the study of 
temporary or permanent sterilization of those temporarily or 
permanently unfit for parenthood,* and on the other hand en- 
courage the study of the causes of sterility and their cure 
in otherwise physically, mentally, and morally sound par- 
ents, so as to improve the human race in general, as it is 
willing to spend to improve our animal industry, what would 
be the result? 



*Henry H. Laughlin : "Eugenical Sterilization in the United States;" Social 
Hygiene, October, 1920. 



BIRTH CONTROL 35 

In answer to this question and in defense of my advocacy of 
a judicious birth control, I should like to quote just a few 
statistics from Holland: 

"What is the physiological effect of voluntary artificial restriction 
of the birth rate? In Holland where the medical and legal professions 
have openly approved and helped to extend artificial restriction of the 
birth rate, the health of the people at large is shown by its general 
death-rate, which has been lowered faster than in any other country 
in the world. At the First Eugenics Congress, held in London in 
1912, it was stated that the stature of the Dutch people was increasing 
more rapidly than that of any other country — the increase being no 
less than four inches within the last fifty years. According to Official 
Statistical Year Book of the Netherlands, the proportion of young men 
drawn for the army over 5 ft. 7 in. in height has increased from 24^ 
to 47^ per cent, since 1865, while the proportion below 5 ft. 2^ in. 
in height has fallen from 25 per cent, to under 8 per cent."* 

What effect has judicious birth control had on the tuber- 
culosis death-rate in that benign country? In a little over a 
decade Holland reduced its death-rate from tuberculosis by 
over 40 points per 100,000; in 1904 its tuberculosis death- 
rate was 184.3 per 100,000 and in 1915 it had fallen to 
144.1. Even in the United States, the country which perhaps 
stands foremost in the attack on the environmental causes of 
tuberculosis, the death-rate was higher, in 1915 being 145.8 
in the registration area. What would it have been had we 
followed the advice of the distinguished President of the 
Second International Eugenics Congress, Major Leonard Dar- 
win, the illustrious son of the illustrious Charles Darwin! In 
his opening address President Darwin pointed out that there 
could be no race improvement without combating both en- 
vironmental and eugenic causes at the same time. Had we 
in the United States attacked our tuberculosis problem also 
from the eugenic side, I believe the result in the reduction of 
our tuberculosis death-rate would have been so startling as to 
arouse the hope of an absolute eradication of the disease. 

In a statement issued a few years ago by Dr. Haven Emer- 
son, then Health Commissioner of the City of New York, and 



*C. V. Drysdale: "The Small Family System: Is If Injurious or Immoral?" Pub* 
liahed by B. W. Huebsch, New York. 



36 FIRST SESSION 

one of the best known authorities on hygiene and social wel- 
fare work, he said that any physician who does not give advice 
to his patient which will, if followed effectively, save her 
from any surgical risk, is not living up to his responsibilities. 
He further said: 

"The patients of the tuberculosis clinics are, in all intents and pur- 
poses, under the personal care of the clinic physician. Wherever the 
patients' health might be jeopardized by the unavoidable risks and 
strains of pregnancy, such patients may, according to my understand- 
ing of the law, be informed as to how to avoid conception." 

I have said that without birth control we will not prevent 
tuberculosis. I go further and say that without birth control 
the number of insane, mentally deficient, syphilitics, and crim- 
inals will not decrease. The support of these defectives costs 
the State of Massachusetts 35 per cent, of its income, and the 
cost of maintaining such institutions in the United States in 
1915 was no less than $81,000,000. (Fisher.) Yet our in- 
stitutional care for this class of dependents in asylums, prisons, 
reformatories, hospitals, etc., is only sometimes curative, some- 
what more often only palliative, but rarely preventative. Birth 
Control scientifically studied, judiciously imparted, and care- 
fully supervised, would in addition prevent such social and 
economic catastrophes as wars and famines, would decrease 
underfeeding and insanitary and insufficient housing, all of 
which are the precursors not only of tuberculosis, but of 
typhus, cholera, etc., and last but not least, of that social dis- 
content undermining the very foundation of our civilization. 

INHERITANCE OF MENTAL DISEASE 
By Dr. Abraham Myerson, Boston, Mass. 

(Unfortunately only a synopsis of Dr. Myerson's paper is available. — Ed.) 

INSANITY is not a unit but is an abstract idea, having no 
existence in itself. What exisfs are mental diseases which 
are distinctly different in type and often of different biological 
natures. 

The statistics are presented to show the marriage rate of 
the various classes of the insane in which it is shown that the 



BIRTH CONTROL 37 

acquired mental diseases do not lessen the marriage rate, 
whereas the congenital types show a marked lowering of 
the marriage rate. A consideration of the mental inheri- 
tance of normal and abnormal is presented, showing that the 
normal frequently have psychopathic heredity. 

The types of mental disease in ancestor and descendants as 
well as of members of the same fraternity is given. It is 
shown that mental disease rarely can be traced over three gen- 
erations and in the majority of cases only in two. The ten- 
dency of mental disease to change from generation to genera- 
tion is shown. Certain mental diseases are not hereditary 
while others have a strong tendency to run in families. 

It is a mooted question whether or not we are dealing with 
true heredity in the transmission of mental disease. The 
writer takes the stand that as a working hypothesis we are 
dealing with diseases of the stock from which the stock may 
recover or from which it may perish just as the individual 
may either recover or die from his diseases. 

THE INDIVIDUAL WOMAN'S NEED OF BIRTH CONTROL 
By Dr. Alice Butler 

I AM not going to apologize, but I must explain to you a 
misunderstanding. I was asked to prepare a paper for 
the evening program. Later I had a letter from the committee 
asking me to take part in the discussion on a subject here 
named. Not knowing that I was to have a paper this morning 
I came unprepared. I will give you a few pages from my 
diary, which I think will compensate for my neglect. 

Just yesterday afternoon, the wife of an attorney, the mother 
of four children, two boys in college in the east, one in high 
school in Cleveland, and a little girl, — I think she is twelve 
years old, — sat in my office in desperation. She was two weeks 
overdue. A tiny little body, forty-four years old, and she 
just did not know what to do. And when I tried to explain 
to her perhaps her condition was the beginning of the meno- 
pause, she said "Yes, doctor, but I am not sure. What shall 



38 FIRST SESSION 

I do?" And when we talked about prevention, I realized that 
she had methods that were not reliable. And that little woman 
walked out of my office, desperate as to what might be, but 
which I did not believe was; but there was no comfort that I 
could give her at all. She positively refused to be comforted. 
As I thought of the nights and weeks ahead of her before the 
problem was really solved, and solved to her liking, I was 
just touched, I could hardly endure it. What the woman needed 
was a safe, scientific, reliable contraceptive. 

Last Saturday I had in my office a bride and groom. They 
were married in August, married for financial reasons. They 
felt that they could economize better by being married. She 
had signed up for twenty-one months of work. After two 
years they expected to begin raising a family and have a real 
family, but she was six days late. She had never been late 
before. She had not slept for three nights. Her eyes were 
swollen from crying, and her husband looked as dilapidated 
as she. We talked the matter over and there was not a thing 
to be done. They walked out of my office desperate, for I could 
do nothing else but say that I presumed she was pregnant, and 
the only thing for her to do was to face the issue, she and her 
husband to face the issue as best they could, and make the best 
of it. "The dear Lord does go before to make crooked places 
straight, and perhaps this child will be the dearest child that 
they ever would have, because children born early in wedlock, 
they say, are very dear." I gave her all that talk for comfort 
sake, but they were not comforted. 

You know their need. A safe, scientific, reliable contra- 
ceptive. 

Early in the summer a woman came into my office. They 
had just recently moved to Cleveland, I think they came from 
Akron, where her husband had formerly been employed in a 
rubber plant, which had now closed down. She was the 
mother of six children, the oldest being eight years old. He 
was without a job. The youngest was a baby nursing, and she 
was pregnant. And I assured her there was nothing that I could 
do but temper the wind to her shorn condition, that I would 



BIRTH CONTROL 39 

see her through her difficulty, and make finances possible. 
She turned on me and assailed me because the medical pro- 
fession would do nothing for a mother with six children, and 
the sixth a baby. You know what that woman needed. 
So those are the individual needs of wives and mothers. 

MEDICAL ASPECTS OF BIRTH CONTROL 
By Dr. Lydia Allen DeVilbiss, Washington, D. C. 

A SHORT time ago an unusual article appeared in the 
Journal of the American Medical Association in which 
the writer stated in substance that "when it was discovered that 
a little crude oil properly applied to the surface of stagnant 
water prevented the development of the malarial and the yellow 
fever mosquitoes, the etiology and pathology of these diseases, 
for all practical purposes became subjects of mere academic 
interest." 

Those who love mankind must hope for the time when hu- 
manity will discover and apply those few cents worth of con- 
traceptive prophylatics which will reduce the appearance of 
the syphilitic foetus, now so common that it does not excite 
our interest, until it will be sought after as a specimen for 
the scientific museums. And along with the syphilitic foetus 
we hope will go into the category of rare specimens of human 
physical life, the diseased, deformed and ill begotten offspring 
of diseased, deformed and ill begotten ancestors. 

When a limb of a tree becomes diseased and withers, the 
horticulturists cut it off. When an animal exhibits atavistic 
tendencies, the stockman sends it to maket. When a human 
family breeds diseased, feebleminded or otherwise defective 
offspring, society feeds, houses, clothes and provides free 
medical succor for them with the result that their offspring 
continue to reproduce themselves interminably and unhindered. 

It should not be inferred that there is any disposition to 
find fault with society for any kindly consideration it may 
show its unfortunate members. If society should surround them 
with every convenience, every luxury, every environment con- 



40 FIRST SESSION 

ducive to human happiness that wealth, intelligence and im- 
agination can conceive, society has not then paid back these 
unfortunates the debt it owes them for having permitted them 
to be born. 

Not one of us would care to accept all the wealth of the 
world and exchange places with the congenital idiot, or the 
congenital physical or moral defective. Few of us would want 
to come into the world into a family in which our coming 
was regarded as a tragedy; few of us would want to be born 
of a woman already depleted with too frequent child bearing 
and consequently not able to furnish us with the sinews of a 
good physical body; few of us would want even to be born 
into a family where our coming meant partial starvation for 
the other already too many mouths to be fed and where our 
life would be condemned to one long struggle for the merest 
physical existence. We cannot of course altogether judge 
according to our own standard what another might want or be 
happy with. However, the Golden Rule is still the highest 
known standard of ethical conduct. 

And this much we know: That if America is appreciably to 
raise the standard of human physical and mental fitness then 
it is essential that every child born on her soil shall be born 
of parents at least free from serious inheritable and com- 
municable diseases who are essentially sound in mind and 
body, and for whose children the necessary creature require- 
ments may be procured. When children are born into fam- 
ilies deprived of one or more of these essentials, it is America 
who must pay the penalty along with the unfortunate ones. 
It is not, therefore, merely in the interests of the unborn that 
we give this subject our consideration — however highly com- 
mendable that altruistic impulse might be — but it is of para- 
mount importance in the interests of our own self protection 
and preservation. 

In America in spite of severe laws and penalties for infan- 
ticide and abortion, and for the dissemination of information 
concerning the prevention of conception, a considerable prac- 
tice of family limitation has developed, as is evidenced by the 



BIRTH CONTROL 41 

undisputedly large number of abortions and the steadily de- 
clining birth rate over a considerable period of time. This 
reduction of the birth rate has been illegal, undirected and 
unintelligent. It has been severely selective, operating chiefly 
in the best American stock, resulting in the so-called American 
family. At the same time there has been no such appreciable 
decline in the birth rate among those living in extreme poverty, 
which is likely to be closely associated with degeneracy, or 
among the feeble-minded and other undesirable strains which 
are increasing at a rate faster than it is possible to build 
asylums, institutions and jails for them. In other words in 
America, there has been Birth Control with a vengeance. 

This Birth Control is bound up with medical, sociological, 
religious, ethical and almost every other division of human 
thought and activities. It is a matter which concerns every 
human being as he develops into adult life. It shapes human 
destinies and the destinies of nations. Handled rightly, it can 
be the one greatest factor in the alleviation of human misery. 
Abused or handled wrongly it precedes destruction. It is 
therefore highly important that we assume a scientific study of 
the principles underlying the control of the birth rate and 
apply these principles for the improvement of instead of for 
the destruction of humanity. 

The most sensitive index we possesses to the social welfare 
of the community is the infant mortality rate. The analysis of 
the causes of death of babies under one year of age shows that 
one-third of the deaths occur at about the first month of life 
and are directly chargeable to influences operating before birth. 
Another third of these deaths occur in the first three months 
of life and are due to causes for which parental influences are 
responsible or to which they are largely contributory. In other 
words the deaths of two-thirds of the babies who die under one 
year of age are due generally to prenatal causes and one-third 
only to all other causes combined. Infant mortality rates gen- 
erally do not include the deaths from abortions and stillbirths. 
If these were added, it might be easily assumed that half or 



42 FIRST SESSION 

more than half of the babies who die under one year of age 
never had a chance to live. 

From this analysis it will be easily seen that the usual and 
popular methods of reducing the infant mortality rates, baby 
weeks, health centers, milk stations, etc., etc., are devoted al- 
most exclusively to the one-third who have survived the period 
of adverse prenatal conditions. The exceptions to this are the 
comparatively few maternal health clinics where proper pre- 
natal and obstetrical supervision is available; and these are 
still for a large part limited to the out-patient departments of 
charity clinics, and to medical college hospitals. 

The great wastage of human life recorded by the infant 
mortality rates cannot be computed in terms of suffering, 
misery and ill health caused the mothers, but its relation to 
the maternal death rate may be approximately known. The 
deaths of women from diseases and accidents of pregnancy 
and labor, if computed for the numbers of women of child- 
bearing age, is found to be several times greater than death 
from any other cause. The tragedy of this high maternal 
mortality rate is that diseases and accidents of pregnancy and 
labor are classed as preventable causes of death and that their 
rate has not shown any appreciable decrease in the last several 
decades. So that for every thousand women who give birth 
to a child, a certain number which may be computed die from 
causes which are classed as preventable and those who give 
birth to a child only to have it die before it reaches its first 
birthday have faced this risk unnecessarily. 

With a reasonable degree of certainty, it can be predicted 
that the offspring of certain parents are likely to be born dead 
or die soon thereafter; or living they will not increase the 
healthy population, but are born to join the ranks of the 
incurables. And of the maternal deaths from diseases and 
accidents of pregnancy and labor, there is a certain percentage 
of women, so far as medical science is able to prognosticate, 
for whom pregnancy and labor means certain death. In fact, 
so dangerous are certain diseased conditions to the life of the 
pregnant women and her baby that obstetric authorities un- 



BIRTH CONTROL 43 

hesitatingly recommend that an abortion be performed, but 
these same authorities do not discuss the desirability of pre- 
venting the conception. 

In addition to the list of undoubted causes of great danger 
to the life of the pregnant woman and her baby, there is a 
much larger list of diseases and disorders of function where 
pregnancy is undesirable until the immediate condition is 
remedied, or the danger removed. The soldier is not permitted 
to go into battle if his physical and mental conditions do not 
seem likely to withstand the strain. But the woman goes into 
the valley of the shadow to produce the soldier without regard 
to the life or health of either. 

Races are not improved, humanity is not uplifted, great 
changes are not effected en masse. It has to be a matter of 
reaching the individual units of the race and through im- 
proving them, the mass is leavened. And in anything which 
so peculiarly and intimately concerns the most private per- 
sonal matters of an individual as the limitation of procreation, 
he must be approached by someone in whom he would most 
naturally repose his confidence in such matters — his family 
physician, the public health doctor and nurse, his minister, 
the social workers, his druggist, and maybe his friend and 
benefactor. And for conveying personal information and 
obtaining response from a national population, large organ- 
izations, national in their scope and already possessing the 
avenue of approach to the individual are essential for con- 
tinued operation. 

It is a common occurrence for a couple to consult their 
doctor, the public health nurse, or social worker when they 
are aware that a pregnancy is existing. Sometimes the con- 
sultation is regarding the health of the mother and child that 
the best conditions for the life and health of both may be 
maintained. Ofttimes it is for the purpose of finding a phy- 
sician whom they may request to produce an environment in 
which the already fecundated cell may not further develop — 
in other words perform an abortion. If the exigencies of the 
situation warrant, the physician may do so, with considerable 



44 FIRST SESSION 

cost of suffering to the mother and even the risk of her life 
and heahh, and at considerable professional risk to himself. 
From this consultation in a pregnancy already existing it is 
but a step further to a consultation of their physician by 
potential parents before rather than after the die of a future 
human being is cast. And it is to the credit of the intelligence 
and awakening conscience of increasing numbers of parents 
that they are questioning their physicians as to their physical 
and mental fitness for becoming responsible ancestors. And 
for those who lack the mental capacity or the conscience so to 
question for themselves, society for its own preservation must 
do it for them. 

For this next step in the progress of human society, the 
medical and the public health professions must prepare them- 
selves. The young men and women in medical colleges do not 
get preparation. They will likely learn no further than how 
most skilfully to perform abortion. Of the possibilities and 
methods of preventing conception, the students will likely con- 
tinue to be kept in blissful ignorance by their professors. In 
fact the subject seems about as taboo in medical colleges as 
elsewhere. That physicians do obtain contraceptive infor- 
mation would seem to be a warranted conclusion which may 
be drawn from the small numbers of children that are cus- 
tomary in doctor's families. The next step is to free this 
information from harmful legal restrictions so that the doctor 
may make it freely available for his patients. 

There is no panacea for Birth Control. There is no one 
simple, safe, infallible preventive. Those agents which undei 
given conditions may act as contraceptives are likely to fail 
when the necessary conditions are not met. In other words 
contraceptive agents require an intelligent selection for their 
use and a common sense understanding of their application 
in order to be efficacious. 

These factors are likely to prove constant. They constitute 
the chief reason why contraceptive agents as such are not likely 
ever to be advertised and sold openly as are some simple 
remedies; but are likely to have placed about them the same 



BIRTH CONTROL 45 

kind of restrictions as are now placed about certain other 
so-called cures and preventives whose advertisement and open 
sale are prohibited by law because they delude the public into 
a safety which is not warranted. If there has not yet been 
discovered a safe, simple, reliable, contraceptive which may be 
successfully depended upon under widely varying conditions, 
any advertisement which conveyed such statement, and pur- 
ported that such agent was efficacious for the purpose so stated 
would be fraud and deceit, and by creating a false sense of 
security would lead its victim to tragedy and misery and even 
to destruction. 

The public must then perforce look largely to the medical 
and the public health profession to take the lead in the dis- 
covery and the application of contraceptive information. This 
is at once a big responsibility and a big opportunity which a 
few most courageous of both professions are trying to dis- 
charge quietly, unobtrusively and to the best of their ability 
— but not nearly so efficaciously as though they were permitted 
to do it openly. In only a few states are there laws which 
would prevent a physician from prescribing for his patient. 
But so long as the whole subject matter is under the ban of 
federal statutes relating to obscenity and criminal abortion, 
the average physician will hesitate to become associated with 
what may be construed as an illegal or an unclean thing. 

The medical and the public health professions cannot be 
held wholly accountable for the condition of affairs. They 
are dependent on the public, not alone for the appropriation 
and the income for the support of their activities, but quite 
as much on the public for that cooperation and assistance 
which will make their activities effective. When the public 
makes it possible for the medical and the public health pro- 
fessions to carry out what they know so well should be done, 
and indeed when they demand that the profession do what they 
know how to do, the whole question will be satisfactorily in 
process of solution in a decade. 



46 FIRST SESSION 

CONSCIENCE AND BIRTH CONTROL 

By Adolph Myer, M. D, 
Psychiatrist-in-Chieff Johns Hopkins Hospital 

I AM afraid my vocabulary has been taken away from me. 
It really is very difficult to speak on this proposition with- 
out one asking oneself, will this word really carry? Have 
we a right to think of scientific? Have we a right to speak of 
scientific? Have we a right to promise? And all that sort 
of thing. I am personally interested from the point of view 
of eugenics; and from the point of view of the happiness of 
those who live, we eugenists say that all of us are keenly 
interested in the problem of Birth Control in the sense of the 
development of a conscience with regard to procreation. It 
seems to me that as far as this conference upholds con- 
science with regard to procreation, there is not one in- 
telligent being in the United States that is opposed or that 
would not give us his best wishes. If there is any diffi- 
culty, it must be about carrying out this program of develop- 
ing and using a conscience with regard to procreation. When 
we come to the actual agitation, we have to admit that we take 
all that for granted; and we want to have one thing — I believe 
here again a large number of us is in accord — we want at 
least one thing, namely, that we shall be allowed to investigate 
and to discuss in perfect sincerity and with responsibility and 
legality, the question of how Birth Control can be attained. 
We have to recognize that we are dealing with individuals who 
are already grown up, and individuals who are growing up, 
moulded by inheritance, and by the circumstances of the edu- 
cational environment, and that under these circumstances the 
ideal solutions which probably a great many of us, myself 
included, would favor and want to work for would not be 
practicable. So we physicians, when we find these distressing 
questions brought to us of ill health due to the blundering 
attempts to have Birth Control, we physicians find our greatest 
difficulty in that conflict of not being able to give legally and 
with the sanction of the good sense of the community, the 



BIRTH CONTROL 47 

advice which we would be willing to give. We have to take 
our consciences as our guide, and suffer more or less perhaps 
in clarity of the advice, perhaps in the effectiveness of the 
advice owing to not being in the position where we could use 
our very best sense. 

The greatest difl&culties are two. In the first place, that it 
is impossible at the present time to limit the advice to where 
it is needed, where it is called for. In the second place it is 
impossible at the present time to give advice which would be 
fool proof. This may be a clumsy phrase, but after all it is 
exactly what I feel is the case. 

Before coming here I happened to speak to one of my col- 
leagues concerning the matter. He told me that today depart- 
ment stores are already supplying materials, not through the 
mails, but through possible channels, and that that arouses the 
suspicion that it is impossible to restrain or to restrict the 
advice to where it is actually needed. And where you give 
advice, you have to say that it depends absolutely on the carry- 
ing out of the advice, and that the unexpected may occur, and 
that therefore one should not put any dependence on methods 
of contraception where there is not at least the general existence 
of risk and the possibility of pregnancy. 

That practically sums up what looks to me like the problem. 
How can we by organizing an educational scheme do as much 
as possible to prevent good and necessary advice from becom- 
ing something that will at once conjure up the antagonism of 
large numbers of people on account of fear that promiscuous 
use will be made of the information. I suppose that the aver- 
age person will say that we have to trust human nature, that 
we have to face a certain amount of bungling, that by the 
proper kind of education we may hope to balance all these 
possibilities, and I frankly say that education will do more 
than legislation on things of this sort. To have freedom from 
sham legislation certainly would be a great first step towards a 
rational managing of the question. And to have those of us 
who are interested in the question under the strongest possible 
moral obligation to see that the constructive part is uppermost, 



48 FIRST SESSION 

not the destructive part. That would be our private conscience 
■ — something that you cannot construct by legislation. 

(Dr. Frederick C. Heckel's address on "Evil Results for Motherhood 
through Lack of Birth Control Information" is unfortunately not available 
for publication. It was given from brief notes, and no record was taken 
of it. — Editor.) 

DISCUSSION 
Dr. Benzion Liber, of New York 

IT WOULD seem from the fact that we have had so many 
physicians speaking — in fact, I believe that only physicians 
spoke this morning — it would seem that the medical profession 
is the one that leads the Birth Control movement. It would 
seem that the medical profession is in accord with this move- 
ment, and not only is it accessible to it, but it is the one that 
gives suggestions and will take us out, so to say, of the mire. 
As a matter of fact, those physicians who spoke today belong to 
a very small minority in the medical profession. As a whole 
the physicians are antagonistic to Birth Control. They are not 
only antagonistic, but they are ignorant of it. So much bo, 
that a couple of years ago the Academy of Medicine of New 
York voted against a resolution for Birth Control, and we 
know that the physicians at large are very much opposed, from 
all sorts of point of view, to Birth Control propaganda. The 
real, and perhaps subconscious reason is, of course, the reason 
of personal interest. Birth Control makes for more health, 
for less disease. Birth Control makes for fewer babies, for 
fewer confinements, for less women's disease and babies' dis- 
ease. I don't say that they are consciously from that point of 
view against Birth Control, but if we cannot help living in 
a society v/here profit prevails, we cannot help being on the 
side where our bread stays. As a matter of fact I don't believe 
that it is correct that we here should decide that Birth Control 
means should be given over to physicians, that they should deal 
with the means and with the spreading of it to the public, and 
so on, because they are not friendly to it, and from another 
point of view because medical science as such is not a preven- 
tive science. Physicians are taught to cure disease not to 



BIRTH CONTROL 49 

prevent disease. As a matter of fact most of the medical pro- 
fession are antagonistic even to public health work, which is 
preventive work, and there is no doubt a great opposition. 
The public health officials have always much trouble with the 
medical profession at large. So it is not to them that we 
have to appeal. We have to go to the public at large, to the 
people at large, and spread Birth Control propaganda among 
the people directly. 

Dr. Knopf 

1HAVE risen again, although I talked long enough, but I 
think I ought to defend the medical profession just a little 
bit. First of all, the gentleman is in error. It was not the 
Academy of Medicine who opposed or did not approve of 
certain Birth Control resolutions, but a County Medical Asso- 
ciation. Secondly I protest against saying that the medical 
profession does not believe in prevention. I have been asso- 
ciated for twenty years with the National Association for the 
Prevention of Tuberculosis. I ask you laymen, and you ladies 
who are not physicians, to tell me whether the National Tuber- 
culosis Association has prevented or not. It has reduced the 
mortality by more than fifty per cent. I ask you further 
whether the Mental Hygiene Association does not prevent 
disease? So I believe we are not as black as we have been 
painted. 

Dr. Patrick, of Virginia 

I WAS very much interested in the comments of some of 
these physicians. I agree fully with Dr. Knopf in all that 
he says with reference to the prevention of conception in 
tuberculosis and in syphilis. I have done in the State of Vir- 
ginia what I could to educate the newly married couples, by 
showing them little booklets, by giving them some advice on 
this point. But there is one danger that I want to call your 
attention to, that some of us have overlooked. Your state 
registrar of New York in 1917 made a study of the statistics 
of New York state. He found that the native-born New York 
people have children at the rate of 17, while the immi- 



50 FIRST SESSION 

grants who have come in from southern Europe, and whom we 
consider as undesirable, are bearing children at the rate of 
90 to 91, as against 17. Let that condition continue for twenty- 
five, thirty, forty, fifty years from now, and where will the 
native American stock be. One of the speakers called atten- 
tion to the fact that these people are not going to be reached 
by Birth Control on account of their religion. If that is the 
case, what are you going to do about the question of Birth 
Control ? We don't need it amongst the native-born Americans, 
and as I look over this audience I don't see any that I would 
consider undesirable citizens. I am thoroughly in sympathy 
with the hygienic problem. I will go further than some of 
those who have spoken. I would even prevent by operative 
measures the propagation of some of the unfit, some of the 
mental defectives and some of the other kinds, and I would like 
to see our state adopt such a law as that. But when we come 
to spreading this information amongst the best class of our 
people, then I say. Will you please stay within the borders of 
New York. Don't go across the Hudson River into New York 
state where you have a birth rate of 17 a thousand amongst your 
native citizens, and for God's sake don't come into Virginia. 

We have in one county in Virginia a birth rate of about 50 
per thousand. Those are every one native-born Americans. 
There are hardly ten colored people living in that county. And 
those are the people which in Virginia and North Carolina 
and South Carolina that have produced such men as Abraham 
Lincoln, and Woodrow Wilson. That is the stock that will 
produce more men of that type, if they are only given a chance. 
What we want is education amongst those people whose chil- 
dren are being born at such a rapid rate, and they are dying 
because the health department has not yet been able to reach 
them. We cannot reach them because they are not educated. 
Bcause they don't attend the public schools; they haven't got 
the opportunity. 

I am a member of the state health department. Dr. Flanagan 
wrote a letter in which he said that I was his father in state 
health work. 



BIRTH CONTROL 51 

That is what I want to call your attention to. You are 
starting at the head, where you don't need Birth Control. 
They are doing it already. In one county in Virginia, in 
Fairfax county, we have a rate of about what they have here 
amongst the native New York State people. I wrote to the 
physicians of that county asking what the trouble was. They 
wrote back to me that they were not only exercising Birth 
Control, but were using abortion. They are holding their birth 
rate down, and that is the county that produces the most de- 
sirable citizens. We would like to have their birth rate in- 
creased up to 50 per thousand if we can. They are able to 
bear children; they are able to take care of them, and they are 
able to do it. 

I married into a large family. My wife is one of ten, nine 
girls and one boy. That boy was afterwards speaker of the 
House of Virginia, and those nine girls are all mothers now, 
those that are married. Now suppose that mother had prac- 
ticed Birth Control, where would those nine girls have been. 
I don't believe in Birth Control amongst people of that kind. 
But yoii can start down here in the slums of New York and 
do it. 

Dr. Myerson 

I WAS very much interested in the native stock argument. 
I thought the Indian was the only native stock. A short 
time ago my father and mother held their fiftieth anniversary. 
We are all immigrants. We came from southern Europe. 
Prima facie we are undesirable. Now in Cumberland, in vari- 
ous parts of Tennessee, in various parts of Kentucky, where 
there are pure Anglo-Saxons, you have a very large percentage 
of insanity and feeblemindedness. In the corner of Massa- 
chusetts that borders on Connecticut — that part of Massa- 
chusetts gives us names of people who are reminiscences of 
the Mayflower — and I had the pleasure, doubtful, of treating 
people there who were feeble-minded. When I was at the 
Thornton Hospital, I made a study of feeble-mindedness in 
Cape Cod. 

Now, I must object to the statement that we are giving the 



52 FIRST SESSION 

advice in the wrong direction. I think he is a little bit over- 
exercised by the fact that Catholics are not going to exercise 
prevention. I made a study a little while ago of Catholics I 
know and they are having a typical family, American family, 
of one child, a dog and a parrot. 

As soon as the foreign stock becomes Americanized, and that 
occurs in one or two generations, they learn from the rest. 
Take an immigrant Jew. An immigrant Jew comes of people 
who have six and eight children, and his descendants have two 
children. And despite the fact that the Roman Catholics stand 
against race control, the very people who protest against it in 
the legislature — ^the Irish Catholic legislators who protest 
against it, to prevent race control to come in as a legal 
measure — have a very small family themselves. I don't be- 
lieve it is because of biological reasons. I am quite sure 
there are contraceptive measures there. As soon as the foreign 
stock becomes Americanized in the sense that it adopts the 
American culture, it adopts the American family too. 

Dr. Johnson 

I WANTED to ask Dr. Vaughan if he did not think that a 
raped woman was a fit subject for an abortion. There are 
more raped women than is supposed, because they sometimes 
don't make it public in order to prevent the damage to the 
individual's life. It seems to me that there is a case where 
the medical profession may very well admit it along with some 
of the other causes. 

Dr. Vaughan 

1 THINK there are lots of cases, as I stated, where it is now 
justifiable to commit an abortion; such cases as advancing 
tuberculosis. But I still say that this society should stand 
firmly on the ground that abortions should never be necessary 
to perform. I admit there is a great deal society has to do 
before abortion can be done away with. That has nothing to 
do with my statement that it should not be necessary at all. 
[Adjournment] 



SESSION II. 

FRIDAY, NOVEMBER 11, 2:30 P. M. 

Mrs. M. Toscan Bennett, presiding 

THE QUESTION OF BIRTH CONTROL DISCUSSED 
FROM A PSYCHIATRIC STANDPOINT 

By Aaron /. Rosanoff, M. D. 
Climcal Director^ Kings Park State Hospital, N. Y. 

IT IS a matter of common knowledge that psychiatry has a 
strong practical interest in eugenics. Psychopathic heredity 
is the most important cause of mental disorders; and so the 
prevention of such disorders is largely a problem in eugenics. 
As yet only a partial solution of this problem has been 
attained. The tendency has been to deal with it in a cautious 
and conservative way, in order to avoid the obvious danger 
of doing more harm than good. Of the measures that have 
been proposed — legal restriction of marriage, sterilization and 
segregation — only the last mentioned has been found at all 
widely practicable; and even it has serious drawbacks and is 
far from being wholly adequate. 

Psychiatry is, therefore, at present in a position to welcome 
further suggestions. 

The question which this paper is to deal with may be 
formulated as follows: Assuming universal instruction in 
technique of Birth Control to be an established fact, what 
would be the effect upon the prevalence of mental disorders? 
I need hardly say here that Birth Control is not something 
new. It is as old as human history. But knowledge of its 
technique has never been equally distributed. In general it 
may be said that in all times persons favored by better en- 
dowment and education have had the more ready access to 
this knowledge. Also, in all classes of society, men have held 
greater power in this matter than women, partly because there 
has been less prudishness in male education, but more largely 

53 



54 SECOND SESSION 

because, for the male part, methods of contraception are so 
simple and so obvious as to be spontaneously discoverable by 
almost any one. 

What I conceive to be new in this movement is the propo- 
sition that by universal instruction and training persons of all 
classes and both sexes be given the full power of Birth Control. 

And so the question, as above formulated, resolves itself 
into two other questions, which are not so general and there- 
fore more readily answered: (1) Under the conditions speci- 
fied, would persons suffering from grave mental disorders 
refrain from having children to a greater extent than those 
who are free from such disorders? (2) Would the relatively 
increased prerogative of women under the new conditions re- 
sult in checking or restricting propagation among psychopathic 
persons? These two questions require separate discussion. 

(1) Under the conditions specified, would persons suffering 
from grave mental disorders refrain from having children to 
a greater extent than those who are free from such disorders? 
It is clear that, unless this question can be answered in the 
affirmative. Birth Control could be counted on possibly to re- 
duce the absolute number of psychopathic persons, along with 
the general fall of birth rate, but not their percentage in the 
population. 

The fact is that psychopathic persons have children, and 
often many children, not solely because of ignorance of con- 
traceptive methods, but because of thoughtlessness, improvi- 
dence, inefficiency, lack of control, etc. Moreover, many of 
them passionately desire children, and, no matter how many 
they have already brought into the world, they continue to 
have more as long as they can, feeling in no way dissatisfied 
with the low standard of care which they are able to give 
them. All this is within the daily experience of psychiatrists. 

It would seem, then, that while well balanced persons 
might be expected to make such use of Birth Control as 
to reduce their families and thus attain for themselves and 
their children a better ordered life of higher standards, psy- 
chopathic persons could not be expected to benefit to the same 



BIRTH CONTROL 55 

extent. On this point we are, therefore, led to the conclusion 
that the percentage of psychopathic persons, instead of de- 
clining, would probably increase under conditions of general 
instruction in contraceptive methods. 

(2) Would the relatively increased prerogative of women 
under the new conditions result in checking or restricting pro- 
pagation among psychopathic persons? 

The industrial and economic organization of modern society 
is such as to restrict greatly the freedom of play of sexual 
selection as a factor in race progress. 

All things being equal, the respective role of the two sexes 
in the play of sexual selection is not the same. 

Fundamentally, and aside from more or less ephemeral 
social compunctions, the male is concerned with scarcely more 
than superficial attractiveness or unattractiveness. He has, at 
the same time, the greater pressure of desire, so that his role 
becomes principally to overcome the resistances of the female. 

In the role of the female, on the other hand, the most strik- 
ing phenomena are resistances and discriminations; and with 
these there is a better natural endowment of discernment of 
personality beneath the surface. 

In other words it is in the nature of things, that the male 
influence is for propagation in general, and the female for 
selection in propagation. 

Psychiatric experience abundantly shows that while normal 
men often have for their mates feeble-minded women, normal 
women mate with feeble-minded men only by way of rare 
exception. 

Under modern social conditions marriage and home build- 
ing generally involve the economic dependence of women; 
and it is this that interferes with the free play of sexual 
selection. 

It may be that the correct remedy for this situation con- 
sists in radical change of industrial, economic and social con- 
ditions. But it may also be that, by merely restoring to 
women, through Birth Control, their natural prerogative of 



56 SECOND SESSION 

determining when and by whom they shall have children, a 
better selected race would result. 

This seems a small crumb for psychiatry to contribute to 
the cause of Birth Control. But I would not have you think 
that I have come here to throw cold water on the proposition. 
Whether, from the standpoint merely of psychiatry, an ad- 
vantage is to be gained through Birth Control or not, matters, 
after all, comparatively little: fundamental human rights are 
here at stake. 

Personally, if I may be permitted to speak not only as a 
psychiatrist, but also as a man, I should say that the Birth 
Control movement ought to be regarded as one of many steps 
in our progress toward human liberation. Such questions as 
how it might affect industrial production, efficiency, national 
strength, etc., must appear to all lovers of liberty as essentially 
irrelevant. 

If for the preservation of the existing order it is necessary 
to enslave women through involuntary parenthood, then there 
is something basically wrong with the existing order. This 
and every other remaining vestige of human slavery must be 
abolished: on this general proposition there can be no com- 
promise. 

It is a false argument which says that, if it be proved 
expedient to do so, involuntary parenthood shall be done away 
with. I say rather, if the heavens fall, it shall be done away 
with! 

EUGENIC ASPECT OF BIRTH CONTROL 
By Roswell H. Johnson 

rIS my task to contrast the effects on racial progress of 
(a) a continuation of the presents status in reference to 
Birth Control with the results that would follow; (b) a repeal 
of the present laws which purport to suppress it and a con- 
structive effort to influence the distribution of Birth Control 
instead. 

The present condition is one truly appalling. We have an 
alarmingly low birth rate from intellectually superior persons. 



BIRTH CONTROL 57 

We have on the other hand a disproportionate contribution 
from the inferior. 

No problem whatsoever is of more importance than the 
amelioration of this condition. Men of the future will have 
the characteristics of the super-fecund and will lack the char- 
acteristics of the sterile or sub-fecund. Our most pressing 
problem is to increase the birth rate from the superior and 
to decrease that from the inferior. The present laws attempt- 
ing to suppress Birth Control utterly fail to hold up the birth 
rate among superiors. When we turn to the inferior, we find 
it one of the most important means by which their relative 
super-fecundity is kept up. 

The evidence on this point is clear and direct. The reasons 
which impel the women who clamor for knowledge on Birth 
Control are poor health, insufficient time for proper recovery 
since birth of last child, and above all, financial inability to 
support the additional children. 

We find then that economic pressure is the greatest potential 
force to hold down the birth rate of the relatively inefficient. 
Its failure to be more effective is the unbidden child. Let all 
children be bidden children and at once there will be a marked 
reduction of the children in the harassed homes. 

Three elements which tend to interfere with this result 
are rapidly being reduced: (1) the extreme simplicity of 
need, such that some individuals of very low earning capa- 
city do not feel their restriction of income. The rapid spread 
of communication and universalization of similar clothes and 
manners which replace the old local simplicities and provin- 
cialisms is making not only all nations and classes more and 
more alike in their spending habits, but giving them similar 
attitudes toward all things, including the dislike of very large 
families; (2) the spread of child labor laws which has gone 
on very rapidly and is still in progress, together with a marked 
simultaneous increase in the cost of rearing children are 
rapidly cutting down the number of families where large fam- 
ilies "pay their way"; (3) there is a rapid increase of social 
capillarity progressing the world over by which parents 



58 SECOND SESSION 

know their children can climb out of their own social and 
financial class if the child possesses the requisite quality 
individually. Class blocking no longer acts as much as for- 
merly to hold down expenditure standards of the less well paid. 

We can confidently predict therefore, that in countries 
like Holland, without the objectionable laws, we have less 
super-fecundity of inferiors and a lesser gap between the 
fecundity of various groups. Studies there paralleling those 
of the United States Children's Bureau, based on size of fam- 
ilies in relation to income, are very desirable. 

The advocates of Birth Control will not be satisfied with a 
negative step such as the removal of suppressive laws with 
reference to contraceptives. They wish to see that Birth Con- 
trol is wisely distributed. Birth Control is not birth repression, 
but truly wise control — that is more births from superior and 
less from inferior. 

When the suppressive laws are removed then our task has 
only begun. We must see to it that the knowledge of means 
of control are made class and world wide. The Aryan stock 
is today the most given to Birth Control and it must see that 
it does not suffer internationally by the relative ignorance of 
inferior stocks. The medical missionary should be thoroughly 
equipped and not hampered from spreading Birth Control be- 
cause his country outlaws it. 

In conclusion, the laws suppressing information and means 
of Birth Control should be removed because by so doing we 
can to some extent prevent the outbreeding of superiors by 
inferiors now going on. 

ORDER OF BIRTH AND THE SEX RATIO 
By C. C. Little 

Carnegie Institution, Washington, D. C. 

IN ANY biological problem dealing with population, the 
ratio of males to females at birth is a matter of consid- 
erable interest. Many statistical investigations of this question 
have been made and it will not, at this time, be profitable 
to attempt to discuss most of them. I shall try to bring out 



BIRTH CONTROL 59 

only three points. Data unless otherwise stated, are from the 
Sloane Maternity Hospital Records, and I am glad to acknowl- 
edge at this time, my indebtedness to the officers of that 
institution. 

1. When both parents are of the same nationality the ratio 
of males to 100 females at birth is 104.54 plus 0.97 (6,000 
individuals). When one parent is of one nationality and the 
other from another, the sex ratio is 122.86 plus 2.14. The dif- 
ference is significant, and when thousands of cases are summed 
up would be economically of interest. For reference the first 
category may be called "pure," and the second "hybrid." It 
will be noted that the latter gives a higher proportion of males. 

2. The above ratios result when all births are massed, but 
when first births are considered separately and are contrasted 
in each group with subsequent births an interesting fact is 
brought out. 

In the "pure" matings, the sex ratio of first births is 115.5 
plus 1.5 and of subsequent births is 97.3 plus 1.2. The dif- 
ference is significant. In the "hybrid" matings, however, no 
such difference exists. 

It appears that in any selected population where a higher 
number of one child families exists than in a normal popu- 
lation, a greater excess of males should be born than in a pop- 
ulation where the "subsequent" children are a higher pro- 
portion of the total number. The economic application of this 
question is obvious. 

3. The work of King with white rats shows that the sex 
ratio of first litters differs clearly from that of subsequent 
litters. The case is closely parallel to that in man and the 
difference is qualitatively similar to that given above. 

This brings us to the all-important conclusion that experi- 
mental studies with laboratory mammals are the most rapid 
and economical means by which a body of evidence can be 
built up to provide adequate information concerning matters 
of the greatest interest and importance to man. 

One has but to read the recent work on Population by Pearl 
of Johns Hopkins to see how well evidence obtained from the 



60 SECOND SESSION 

fruit-fly Drosophila has been applied to the problems of 
human increase. In a similar way today we are attacking the 
cancer problem from a new angle that offers great oppor- 
tunity. In no less a degree may we expect that investigation 
of the effects of Birth Control on rats, rabbits, and other lab- 
oratory mammals, might do much to determine the merits or 
demerits of a somewhat similar situation in man. 

The biologist has come to demand this experimental method 
in his own problems and his support to any viewpoint or issue 
is more readily obtained after these methods have been criti- 
cally and extensively applied to the problems under con- 
sideration. 

PROBLEM OF THE DELINQUENT WOMAN 
By Virginia C. Young 

1AM HERE this afternoon to speak for those who cannot 
speak for themselves. You who are gathered for this Con- 
ference are the "illuminati" of this movement; while all 
around you, outside these walls, lies the great world of every- 
day men and women who are to furnish the field for your 
adventure and research. But there is a strata of Society lying 
still lower and underneath, which has also its importance and 
significance to you, and of which I would speak. 

The problem of the Delinquent Woman — I had almost said 
of Primitive Woman — Woman in the making. The great resist- 
less, onflowing tide of advancing civilization has what might 
be called its beaches — our great cities — where the flotsam and 
jetsam of human progress heaps up highest, and where we 
find, swept up from the deep sea of life, two crude and 
significant remnants of an unfinished world, — the City Negro 
and the City Prostitute. 

It has often been pointed out to us that the long ages of 
shelter and seclusion of women in the harem and the home, 
have bred a good half of the human race singularly unfitted 
for the struggle of the outside world. Many have noted and 
stressed the importance of the fact that too often, when women 
are forced out of the home, they have succumbed, and the 



BIRTH CONTROL 61 

dove of the home-nest has become the vulture of the street. 
This is one of the conditions which have become lamentably 
noticeable in a world which seems now to have lost itself for 
a time, to have let go of those lofty ideals which, beautiful in 
themselves, yet, based on the quagmire of war, had no 
enduring foundation, and have been so rudely shaken. 

Last summer I stood on Inspiration Point in the Yellow- 
stone Park, with a group of tourists, who like myself were 
rendered for the moment dumb by the sumptuous mag- 
nificence of that titanic panorama. Some turned away, 
dazzled by the splendor of the scene and there was a feeling 
of almost childish relief when the guide pointed out, far be- 
low where we stood just high above the river-floor, and safe 
as Heaven itself, a rude nest filled to overflowing with ugly 
and squawking young ospreys, with a brooding and anxious 
mother and a hovering and hard-working father. There was 
something we could all understand and talk about — that little 
home, full of noisy busy-ness in the very midst of cosmic 
grandeur. So, the modern man turns from the fierce com- 
petition of the market place to the nest, far up perhaps in 
one of our modern cliff-dwellings which is reached, not by 
strong wings, but by the apartment house lift, to enter with 
his latch-key a little kingdom of peace and love, that inner 
shrine of the Woman and the Child whose worship has fed 
the heart-hunger of the world. For, as George Eliot has ex- 
pressed it for us, "In these delicate vessels have been carried 
down through the Ages the treasures of men's aff"ections." 

But it is the other woman of whom I would speak today, 
she whose behavior and whose destiny form so large and 
important a part of this problem of the production of the 
unfit in which she bears so large and terrible a share; for 
her power of child-bearing is one of the ugly realities which 
is stronger than subterfuges or veneer, and has a disconcert- 
ing way of breaking through and demanding attention in a 
Conference like this. 

Now it happens that I know this other woman, and some 
of her offspring, not from report or hearsay, but by daily 



62 SECOND SESSION 

contact with her in the house where we live together, side 
by side. I have also had the opportunity of visiting some 
forty of the State Reformatories and Prisons for Women 
throughout the country, and have come to know in this way 
several hundreds of young American women of the so-called 
delinquent class, all of them potential mothers, many of them 
already mothers, and most of them so badly-born themselves 
that they might often be said to have been "damned into the 
world." 

And everywhere throughout this great West of ours, some- 
times on the very farms where these girls are incarcerated, 
I found tlie most interesting and successful experiments and 
results based upon careful scientific methods along the lines 
of bettering both seed and stock in both agriculture and 
animal-culture. Everywhere in that teeming and abundant 
land, one finds offered to farmers, their wives and their chil- 
dren, abundant opportunities for information and instruction 
as to the raising of better and ever better grades of pigs, 
pigeons and potatoes — of clover, chickens and cheeses — of 
butter, bulls and bacon — of Belgian hares and Labrador rein- 
deer. On these ranches mongrels are non-existent and their 
presence would be considered an evidence of reprehensible 
carelessness. Out there men do not speak of "Cows," but of 
Jerseys, Guernseys or Holsteins; not of "chickens," but of 
Plymouth Rocks or Rhode Island Reds. In Nebraska it is 
against the law to introduce into the herd any but registered 
bulls. 

Only the most important of all animals, the crown and 
flower of all life — only MAN is permitted to follow his 
own wild and wilful way in the matter of reproducing his 
kind. It is only the young of the human species which are 
bred by chance or whim, caprice or accident; which may, as 
it were, saunter carelessly into a world so desperately needing 
strong and capable hands, clear and logical brains, warm and 
unselfish hearts. This most-of-all-needed creature, with tlie 
supreme endowment of an immortal soul, may come into being 
as the result of the wedding of unhealthy, igibecile, intern- 



BIRTH CONTROL 63 

perate and lustful men and women. Yes, we must dare to put 
into words these crude and ugly facts in order to fully realize 

how monstrous it all is. 

We often hear thoughtful people raise the objection that 
if the prostitute women of the country were given information 
which would make it possible to follow their hideous career 
without " the fear of consequences," that there might be more 
girls tempted to follow this profession. It is necessary for 
some of us who do not know such ugly facts, to be told that the 
women of the street are the very first to know all there is to 
be known as to self-protection. And in addition might it not 
be urged, degrading and unwomanly as is such a career, at 
least a woman who deliberately chooses to befoul herself 
should not be allowed or encouraged to pass on the taint of 
soul and body to innocent children, unwanted and unfit. Of 
two serious evils, which is the worse — some increase in the 
number of existing degenerates, (and we are told that the 
average life of the prostitute is three years — when disease or 
death puts an end to her wretched career) or the passing on, 
for who shall say how many generations, of a heritage of 
weakness and disease, physical, mental and moral? 

Oh the shame of it! That we who frame such drastic 
laws against the entrance, through our National Ports, of 
undesirable aliens, must yet bear the heavy burden of this 
continuous and polluted stream, through what Whitman called 
"the delicate, beautiful gates of life," of the badly born, 
crowding out, as they most surely do, the better babies which 
this world so sorely needs. For let me remind you that it is 
just now the great and vitally important middle-class who are 
feeling most the economic pressure of the times, and these are 
they who most need guidance and help as to their part in re- 
making a world with "not more of us, but a better brand 
of us." 

We are here, surely, to face facts frankly; and we who are 
guiding the younger ones in what has been described as "both 
the science and the art of living," must realize that marriage 
at the mating age is the only safe and normal way for young 



64 SECOND SESSION 

Americans; that it is equally, if only too sadly true, that 
the average young man cannot support a too rapidly increas- 
ing family. 

In our American history we have exalted the large family — 
and rightly, but the large family of which we think, the good 
old vanishing stocks which furnished the makers of this nation 
— those sternly-reared but fortunate children — were raised in 
New England farmhouses, or in small conservative towns in 
which their parents played a leading part in State House and 
Church and on School-boards and Town Meetings. Those were 
the days of plenty of good food, of simple wants, and simple 
living. Who can visualize such a family group transferred to 
the twentieth floor of a modern flat-house, and gathering 
around a steam radiator or even saying its prayers beside a 
folding-bed, already occupied by younger brothers and sis- 
ters? What mother of ten or twelve children in a crowded 
tenement has time for those gentle ministrations which are 
the very essence of real Mothering? What modern, hard- 
pressed father can think of supplying any but the bare physi- 
cal needs of his brood? What time has either parent to con- 
sider tlie insistent needs of adolescent girls and boys, who find 
their only mental and spiritual food in the hectic and often 
unclean movies. 

Mr. H. G. Wells was aroused to the point of out-spoken 
indignation by a caption in an English paper, — "Should 
Bank Clerks Marry?" "How do we dare," said he, "to calmly 
discuss, to weigh and measure the perfectly natural inclina- 
tions and behavior of a perfectly normal and natural section 
of the world in which we live. What have we come to when 
we say to these young people, *not you, but we must decide 
this.' " But read the article yourselves, dear audience, and 
ask yourselves whether we are not making marriage practically 
impossible for many young lovers of our modern world. 

I was reminded recently that William James once said that 
what the world needs most is "a moral equivalent for war"; 
something equally compelling, equally appealing, demanding 
equal sacrifices and self-forgetfulness, with banners and ori- 



BIRTH CONTROL 65 

flammes and leaders, with the same sort of appeal to the 
highest and noblest in men and women, — ^but with an End in 
view which shall be not Death but Life — not the extinction of 
our best and bravest, but a fostering of all that is beautiful 
and worthy and precious for the strengthening and enriching 
and glorifying of human life. 

James felt that it must be our own United States which 
must present this program. May we not feel that this Con- 
ference proves that it must be rather a joining of the two 
groups from both sides of the Atlantic, which must unite for 
this modern Crusade? For this is surely the driving of the 
silver spike which marks the coming together of the two gangs 
of workers from England and America who are met here for 
the simple yet impressive gestures of sympathetic understand- 
ing and co-operation. 

And I would most humbly leave to the specialists whose 
labors are a most noble kind of consecration, the difficult 
and important task of meeting and solving the great question 
of populations which is one of the real questions of the hour 
among the many which must be solved by those who are seek- 
ing the causes and the cure of war and economic disturbance. 

It is for the distinctly spiritual values underlying this move- 
ment that I would plead. It is not primarily for the emanci- 
pation of woman from the age-long bondage of an undirected 
mothering of mongrels; it is not even the goal of a race of 
splendid athletes and Amazons that interests me most. But it 
is the hope which I find in this movement of the possibility of 
the gradual coming into being of a race loving beauty and 
the finer things of life, and demanding and claiming them. 
The coming of a time which John Galsworthy has pictured in 
his "Green Hill Far Away," a time when the majority of 
Mankind shall choose beauty rather than ugliness, the riches 
of the spirit rather than the piled-up horde in the bank- vault; 
when men and women shall love each other not less, but more; 
when they shall be unafraid of love because nobly sure of a 
life together thought out with wise and tender wisdom for 
the bearing and rearing of only wanted and planned-for chil- 



66 SECOND SESSION 

dren; when Celibacy shall be no longer exalted and laid as 
the supreme gift on our churches altars, but when the Fine 
Art of Parenthood shall be laid there instead and every child 
shall be, like the Child Samuel, an offering unto the Lord; 
when every child shall come through those noble gates of 
life bearing in his hand rich gifts for Life itself. 

Does this offer a Moral Equivalent for War? Let the 
Unborn speak, — 

"From the Unseen I come to you tonight, 

The hope and expectation of your world. 

I am Omniscience that seeks of you 

A tongue to utter the eternal thought. 

I am Omnipotence that claims of you 

The tools whereby my power may profit Earth. 

All Love am I, that seeks to spend itself 

Embodied in a human sacrament. 

What welcome will you give to me, World? 
What is the home you have prepared for me? 
man and woman who have fashioned it 
Together, is it fine and clean and strong? 
Made in such reverence of holy joy. 
Of such unsullied substance, that your hearts 
Leap with glad awe to see it clothing me? 

Thus will I call till all mankind shall heed 
And know me, who today am one with God 
And whom tomorrow shall behold, your Child." 

BIRTH CONTROL AND RURAL SOCIAL PROGRESS 
By E. C. Lindeman 

Professor of Sociology, North Carolina College for Women; 
Field Secretary, American Country Life Association 

IF I were asked to propose a statesmanlike, scientific, and 
condensed program for alleviating the present tendencies 
toward decay in modern civilization, I should include in my 
recommendation : 



BIRTH CONTROL 67 

1. The cancellation of all war debts on the basis of immediate 
and complete disarmament. 

2. The democratic organization of all nations of the world for 
the purpose of cooperative, unified progress — and for the 
purpose of providing a rational method of discussing and 
solving international disputes. 

3. The rapid dissemination of scientific knowledge regarding 
the limitation and the improvement of the human popula- 
of the world. 

The first recommendation involves the removal of financial 
burdens which are destined to keep certain nations en the 
border of disintegration until these burdens can be lifted. It 
involves also the establishment of immediate international peace 
by destroying the tools of war. It would restore financial 
equilibrium, reduce taxes, and secure temporary peace. 

The second recommendation involves the continuation of 
both international and economic peace by granting equal rights 
to all nations. Its purpose is to project the temporary peace 
until it becomes a permanent peace. 

The third recommendation deals with the problems of dis- 
crepancy between the goods (land, food, et cetera) available 
to the people of any given time and the consumptive needs of 
those people. Over-population may or may not be one of the 
primary causes of war, but it is undoubtedly very frequently 
the cause of serious economic disturbances which lead to war. 
This recommendation contains, however, other far-reaching 
implications of a physiological, sociological and ethical nature. 
To exercise conscious control over the number of people 
brought into existence implies that man is not subject to the 
inexorable forces of natural selection and survival in the same 
degree as are animals. It implies further that man may be- 
come interested in the quality as well as the quantity of his 
biological projection. 

I have come to be sufficiently disillusioned during the past 
decade to recognize the fact that the first two recommendations 
will not be acted upon in a statesmanlike and scientific manner 
until our civilization is nearer decay than it is at present; it 



68 SECOND SESSION 

may then, of course, be too late to apply these remedies. But, 
I am hopeful of the success of the third suggestion because its 
propagation need not await the slow conversion of professional 
politicians; the dissemination of scientific knowledge regard- 
ing Birth Control awaits only the courageous words of honest, 
superstition-freed, and intelligent persons. 

If I were asked further to state which portion of the world's 
present population needed the advantages of the third sugges- 
tion, I should unhesitatingly answer in terms of those who live 
in the open country, villages, and small towns. My reasons for 
this assertion, it is hoped, will hereinafter be made plain. 

Some Rural Facts and Their Significance 

I. 

The theme of this essay is the relationship between Birth 

Control and rural social progress. It will be necessary to 

review certain facts regarding the rural aspects of the modern 

world before assuming to state conclusions. 

In spite of the unprecedented growth and development of 
cities during the last seventy-five years, there are still more 
people living in the country than in the city. What is of greater 
importance is the fact that those who now live in cities are 
increasingly dependent upon those who live in the rural areas. 
As the proportionate rural population decreases, so will the 
acuteness of the rural problem increase. A brief analysis ot 
the populations of a few representative nations should convince 
us of the significance of our rural dwellers: 

The population of Russia is 80 per cent rural. 

The population of India is 90 per cent rural. 

The population of China is 90 per cent rural. 

The population of France is 50 per cent rural. 

The population of England is 22 per cent rural. 
The above may be taken as a representation of the present 
population of Europe and Asia. The North American conti- 
nent is, as a whole, still dominated by its rural group; while 
the United States is gradually becoming an industrialized oi 
urbanized nation, more than one-third of its people still reside 



BIRTH CONTROL 69 

outside cities. The total population of the world is undoubtedly 
divided approximately on the basis of 75 per cent rural and 
25 per cent urban. If Birth Control is ever to become a part 
of the consciously-contrived statesmanship of the world, its 
message will, perforce, need to be brought to the rural popu- 
lations. 

II. 

The significance of the rural population is further increased 
by a consideration of the birth-rate. Statistical evidence need 
not be assimilated to support what is common knowledge, 
namely, that the size of rural families is greater than that of the 
city families. The families of the working classes in cities tend 
to decrease slowly; the families of the middle classes (com- 
mercial and professional) and the so-called upper classes tend 
to decrease rapidly. It is one of the features of city life to 
bring into being a constantly increasing middle class forced to 
subsist upon an income which is, within narrow limits, fixed. 
This class cannot produce large families. The so-called upper 
classes have already reduced the size of their families, not 
according to financial inhibitions, but in accordance with sel- 
fish motives. The food supply of the farm is more flexible than 
that of the middle classes in cities; consequently, the farmer is 
not obliged to limit the size of his family by reason of economic 
pressure. 

A few years ago, when the population of this country was 
divided in such manner as to place 60 per cent of the total in 
cities and 40 per cent in the country, the school census indicated 
that these figures would need exact inversion in order to depict 
the respective child populations. In other words, while the 
city contained 60 per cent of the total population, the country 
contained 60 per cent of the school population, and the cities 
only 40 per cent. 

Cities grow by accretions from three sources. Roughly 
speaking, 2 per cent of the city's increase comes through immi- 
gration from foreign lands. (In analyzing the size of city fam- 
ilies, one must take into consideration that the families of 
immigrants are likely to be largely rural; at any rate, the first 



70 SECOND SESSION 

and second generations are likely to maintain a larger sized 
family ratio than will be true of the succeeding generations. 
This fact tends to make the size of the city family appear 
larger than its norm should be). Nineteen per cent of the 
increase represents the natural increase of births over deaths. 
From 10 to 15 per cent of the city's growth can be accounted 
for only on the grounds that it is drawn from the surrounding 
rural areas. This means that the country must not only main- 
tain a sufficient supply of births for the repopulation of its own 
areas, but it must, in addition, furnish one-half of the city's 
increase. Some observers have concluded that the city receives 
its rural quotas only during unusual periods of industrial ad- 
vancement. A longer view of the problem seems to indicate 
that this phenomenon has always existed, namely, that cities 
tend to decrease the size of the family and that rural areas make 
up the deficiency. 

All of the above means that the majority of the children of 
the nation are born in rural communities and probably will 
continue to be thus born for some time to come. It means 
further that if Birth Control is to be one of the means of pro- 
viding children with a better birth, a better childhood environ- 
ment, and better parents, its mission will need to extend to the 
rural areas where most of the children are brought into exis- 
tence. 

III. 

The third series of facts regarding rural life which needs 
emphasis has to do with the problems of health. The country 
doctor, of poetic fame and heroic proportions, is a rapidly 
disappearing entity. In towns of over 2,500 population, there 
is one doctor for every 500 people; in rural areas there is one 
doctor for approximately each 1,000 people. In some places 
it has been found necessary and expedient to subsidize the 
country doctor through private or public funds. 

The rural nurse, who is the health propagandist of the coun- 
tryside, is coming to fill the gap left by the vanishing doctor. 
Of the 10,000 public health nurses in the United States, about 
four-fifths are located in cities. The remainder must spread 



BIRTH CONTROL 71 

their services to meet the needs of 40,000,000 people who live 
in the country. But, the public health nurse is not a physician. 

Under conditions of modern life, child-birth is a physio- 
fogical function which demands scientific interpretation. Tho 
modern social structure is so tensely inter-related that we can 
no longer allow children to be born in ignorance. This is 
not because we are driven to assume a higher regard for the 
new-born child itself, but because that child's birth affects other 
lives in a most intimate manner. The mid-wife of the country- 
side, the superstitions, and the quackery related to child-birth, 
must be supplanted by plain facts and simple truths. The city 
mother has the privileges of medical attention and advice 
which may be secured quickly. Leaving out of consideration 
the distance and time element, the city mother may have a 
physician at her home with one-half of the difl&culty encoun- 
tered by the country mother. She has about seven to the coun- 
try woman's one likelihood of having the services of a nurse, 
and the possibilities of the country woman's hospital care are 
far less favorable. 

The country mother, under existing circumstances, is obliged 
to bear the burden of bringing forth the largest number of 
children; she has to perform this function under handicaps 
which render her opportunities of success far less than those 
of city mothers. 

IV. 

As the division of labor in economic production increases, 
so will the opportunities of the working classes to lift them- 
selves out of their classes diminish. Most of our present 
leaders have either a first or a second generation rural back- 
ground. They succeed in the struggle towards what we call 
success, not because the country has provided them with a bet- 
ter education, but rather because there is a certain kind of 
education in farm life, itself, which produces hardihood, skill 
in meeting emergencies, persistence and other qualities which 
enable them to survive. The country boy who succeeds in the 
city is a subject of romance. If we were more realistic, the 
country boys and girls who fail in our cities would constitute 



72 SECOND SESSION 

a basis for tragedy. But, we adhere to romanticism; it is 
pleasanter to think of those who rise from farm boys to bank 
presidents. The plain truth of the matter is that children born 
in the country are not securing the sort of education essential 
to progressive living in the modern world. Of the 22,000,000 
children attending our public schools in the United States, 
11,000,000 are enrolled in one-teacher schools. Eight millions 
more attend two and three-room schools in rural communities, 
towns and villages. In 1912 the cost of educating a city child 
was $32.00, while the amount spent on the education of the 
country child was $13.00. The shorter term and the poor 
school attendance cause the country child to receive six years 
of elementary training while the city child receives eight. The 
health of country school children is unwarrantedly inferior to 
that of city children. Recent examinations have revealed whole 
school enrollments with physical defects. The country teachers 
have inferior preparation, receive lower salaries, and remain 
at their posts from one to two years. The sum of all of these 
educational defects means simply that the country child has a 
far smaller opportunity of securing an education than has the 
city child. We ought not to be unduly shocked when we learn, 
consequently, that illiteracy is twice as great in rural areas as 
in urban areas. 

Rural education is improving, but the rate of progress is too 
slow in comparison with other social changes. It is not enough 
to lay the blame at the feet of the farmer-taxpayer. The 
farmer's income from his labor is extremely low. When the 
interest on his investment and the products consumed by his 
family are deducted, the average labor income of the farmers 
of the United States is less than $1,000.00 per year. (Excep- 
tions must be made, of course, for unusual periods such as the 
War years of 1915-17.) 

All serious students of the country life problem are aware 
of the fact that the country needs quality in its population 
rather than quantity. The application of machines to farm 
labor may still be greatly extended; it may be possible to 
maintain production at a sufficient level with a reduced popula- 



BIRTH CONTROL 73 

tion. But, it will not be possible to produce a rural population, 
with those qualities and native capacities which make the 
country the seed-bed of our population, unless the people who 
are born in the country and remain there as farm folks ascend 
the scale of human improvement. The answer seems plain 
enough: a reduced birth-rate accompanied by the other fac- 
tors of social improvement should make it possible for the 
farmer to accelerate his speed of progress — at least in the 
field of formal education. 

The foregoing paragraphs merely hint at the significance of 
certain aspects of rural social progress and the relationship of 
these to rationalized parenthood. Rural social progress, like 
all progress, cannot be measured by the length of the graph 
representing any one phase of life. Social progress implies a 
progressive movement "all along the line." Different emphases 
must, of course, be made at various times. It is my opinion 
that the emphasis which needs now to be made is that which 
impinges upon the life of the country woman. Either life in 
the country is to be made more than tolerable for her — lift 
her into the sphere of cultural, political, recreational sig- 
nificance — or farming will need to be industrialized and what 
we now know as "country life" will become a thing of the 
past. No one who appreciates the revolution which is now 
taking place in the intellectual life of women on the farms can 
escape the above conclusion. 

The minimum requisite for the new role which woman is to 
play in country life is that she shall be freed from the un- 
necessary burdens of irrational childbearing, and that her sex 
life shall be so ordered and interpreted as to give assurance of 
the reproduction of the right number of children reared in the 
atmosphere of wholesome and optimistic progress. The old 
fears, the old prejudices, the old hypocrisies, and the untold 
mental and physical sufferings of the long-patient country 
mothers are abnormal and unethical and must pass away. The 
pathway toward this deliverance is at hand. A new joy and a 
new hope and a new promise will spread its light over the 
countryside when the shrouds of superstition, mysticism, and 



74 SECOND SESSION 

bigotry are lifted and the child-bearing of the country woman 
becomes what it ought to be — a rational, scientific, orderly, 
and frank facing of one of the beautiful realities of life. 

THE GREATER FREEDOM BY BIRTH CONTROL 
By Harriette M, Dilla 

Smith College, Northampton, Mass. 

THERE have been so many excellent papers presented 
at this Conference, that it seems there is little left for 
anyone to say, especially from the Sociological point of view 
because Sociology is, as you know, a composite of other 
sciences, though it can scarce be called a science, itself. 

There are two preliminary postulates which we shall wish 
to remember, and make clear in the minds of others. In the 
first place, it is a fact that no movement by itself is self- 
sufficient, and as members of the movement for Birth Control 
I am sure that we do not claim that it alone is adequate to the 
tremendous needs of society. We must be largely dependent 
upon, and certainly co-operate with, all the splendid agencies 
that are working at present. 

The advocates of Birth Control are deeply indebted to 
many agencies for their sources of information and their 
arguments. Their foundations are facts that have already 
been presented. It remains only to point out the relationships 
so tardily discovered. 

Among the most valuable sources are the United States Cen- 
sus; the publications of the United States Children's Bureau, 
especially the Studies of Infant Mortality in Johnstown, Pa., 
Manchester, N. H., Waterbury, Conn., Brockton, Mass., Sag- 
inaw, Mich., New Bedford, Mass., and Akron, Ohio; the Studies 
of Infant and Maternal Mortality in Rural States; the Study of 
Maternal Mortality in the United States by Dr. Grace L. Meigs; 
and the Statistical Report of Infant Mortality for 1920 in 519 
cities of the United States published by the American Child 
Hygiene Association, formerly the American Association for 
the Study and Prevention of Infant Mortality. Of special 



BIRTH CONTROL 75 

value are the data presented at the hearing before the Committee 
on Public Health and National Quarantine, United States Sen- 
ate, 2nd Session, 66th Congress, 1920, on Senate Bill 3259, for 
the Protection of Maternity and Infancy. The evidence of Dr. 
Anna E. Rude is extremely valuable. 

First among the sources is the recent volume of Mortality 
Statistics of the Census Bureau, which shows the extent of 
Infant Mortality by causes, based upon the international de- 
tailed disease list. The arrangement in five columns follows 
the plan of the United States Children's Bureau in its pre- 
sentation of causes of Infant Mortality. Some of these facts 
have been pictured by a series of charts. You will be im- 
pressed with the fact that the first column, — ^the tallest column 
in every one of the twelve large cities but Chicago, — repre- 
sents the groups of natal and prenatal causes. Does this mean 
that there are pathological conditions among mothers before 
conception, as well as before birth, which are producing 
death? If so, how can a woman, in the state of marriage, 
who possesses these defects, postpone motherhood until these 
fatal conditions are overcome? 

Is a Maternity Clinic with its excellent prenatal advice 
adequate when it prescribes for a woman after pregnancy is 
entered upon? Or is it true that pregnancy ought to be de- 
ferred until the condition is favorable for maternity? 

A recent statement by a notable authority throws some 
light upon this question. Mr. Louis I. Dublin of the Met- 
ropolitan Life Insurance writes as follows in an article in the 
Statistical Bulletin for July 1921: 

"The city of New York, for example, gives 85 infant 
deaths for 1,000 births in 1920, as compared with 
81 in 1919. These are discouraging facts, because in 
this city serious efforts have been made for a number 
of years to cut the infant mortality rate through ex- 
tensive prenatal care of mothers." 
The dilemma is presented clearly here. Does it seem that 
prenatal care must be supplemented by something even 
more fundamental? Something that will discern and take 



76 SECOND SESSION 

cognizance of the pathological condition of the mother before 
pregnancy is entered upon? 

The long-neglected subjects of Infant and Maternal mor- 
tality furnish the most compelling evidence of social wastage 
under our present limitations. But there are other channels 
of social wastage, — child dependency and delinquency. 

How many dependent children are there in your state and 
why are they dependent? So far as the State of New York 
is concerned, the Secretary of the Children's Division of the 
State Board of Charities tells us in his last report that there 
are a large number who have one or both parents living. Then 
why are they dependent? He enumerates these among the 
conditions prevailing : (1)' father or mother, or both, at work, 
or seeking employment; (2) insufficient earnings; (3) un- 
employment; (4) large family. 

With these facts in mind do you feel that there is any re- 
lationship between the dependency of large numbers of chil- 
dren with one or both parents living, and the power of vol- 
untary parenthood? 

How many delinquent children are there in your state, who 
have passed through the courts and have left the records of 
their misfortune? One chart in the recnt Exhibit of the 
International Congress of Eugenics showed that almost half 
of the children brought before the psychopathic clinics of five 
of our leading juvenile courts had an unbroken home en- 
vironment. Then why are they delinquent? Researches in 
juvenile delinquency answer this question by pointing out the 
demoralization of home conditions through poverty and the 
tragic results of poverty. And still is it not true that families 
which are incapable of rearing children are permitted to con- 
tinue to bear them. Society denies to them the greatest power 
of all, — ^that of self-help, — and later society pays the price. 

Therefore the Birth Control Movement is not inharmonious, 
but entirely compatible with the eugenic measures of steriliza- 
ation and permanent custodial care of the mental defective 
and congenital criminal. At times I find a tendency to con- 
found Birth Control with sterilization and custodial care. 



BIRTH CONTROL 77 

Birth Control is a measure requiring intelligent understanding 
of reproduction by the responsible classes in society. The 
reproduction of the irresponsible classes must be regulated by 
society, itself, and among the methods that have been favored 
are sterilization and permanent custodial care. 

In the second place, when a new problem is presented to 
us, it must be considered from an entirely unprejudiced point 
of view. It is a great injustice to ourselves, I think to impose 
upon our reason the limitation of prejudice. We are not 
going to do it nor encourage it upon the part of others. We 
have then two preliminary postulates, first there is need for 
co-operation with every present agency doing genuine work 
in society; and second, each new movement deserves fair con- 
sideration by a free mind. We know that fear and scientific 
freedom are incompatible. 

A discussion of Birth Control from the Sociological point 
of view would be incomplete if its relation to Eugenics were 
not emphasized. For the sake of brevity and clarity, may we 
observe the somewhat dogmatic division into Positive and Neg- 
ative Eugenics? 

Under Positive Eugenics, we shall consider racially fit 
individuals, with high standards of life, high valuation of 
family relationships, and an appreciation of the economic ob- 
stacles to realizing them. 

1. Have we ascertained the proportion of such individuals 
who remain celibate because economic conditions do not justify 
assumption of family responsibilities based upon an uncon- 
trolled parenthood? Theirs apparently is the choice between 
celibacy and a parenthood which they are not permitted to 
control. Amidst economic stress and uncertainty they choose 
the former, and can we censure them? 

2. If there are such, would the power of self-determined 
parenthood help to remove the barrier to marriage and even- 
tual parenthood? If individuals of this class were permitted 
to exercise their judgment in this, as in infinitely lesser realms, 
would a considerable number be happy to assume parenthood? 

3. If so, would this fact tend to increase the number of 



78 SECOND SESSION 

family units among the racially desirable, and bring greater 
numbers within the sphere of potential parenthood? 

4. If so, does it seem that the power of control of parent- 
hood is of interest to Eugenists as one promising possible 
solution of this problem? 

Under Negative Eugenics we shall include, among the 
racially less desirable, only those who possess sufficient in- 
tellect and control to render them responsible individuals. 
The irresponsible, it is obvious, must be excluded from our 
consideration, and their reproduction subjected to social con- 
trol. 

Is it not true that Eugenists have hoped to preclude dis- 
genic parenthood by directing their interdict against mar- 
riage? Have they not, in this way, identified parenthood with 
marriage, and attempted to prevent the former by enjoining the 
latter? I refer to the racial conscience which they hope to 
build up among responsible individuals. Now we may ask 
ourselves this question: 

What proportion of the racially disgenic individuals 
conform to this racial standard, and what are the results 
of conformity and non-conformity? 

First, there are those who conform and do not enter upon 
marriage. The men of this group decide to live celibate, and 
it is only fair to them to suppose that they intend to live con- 
tinent. But they find the world as lonely as it is populous, and 
as many disappointments as there are expectations. The 
monotony of gray life in drab furnished rooms becomes un- 
bearable. Stress of effort, strain of disappointment and re- 
sistance to the great drive in human nature are sometimes too 
much, and the hope to live continent fails of realization. 

If this is true, does it seem that a possible aftermath of 
conformity to our standard may be promiscuity of sex-rela- 
tionship? And may this be true also of the unmarried class 
whom we considered under positive Eugenics? Can race and 
promiscuity profit at the same time, especially that factor of 
promiscuity which we term prostitution? 

And if we pass to the further problem of illegitimacy, re- 



BIRTH CONTROL 79 

suiting from promiscuity, shall we be compelled to confess 
that at times we suffer additional defeat? Parenthood through 
marriage was discouraged, and to some extent — we do not 
know how great the extent — parenthood independent of mar- 
riage has arisen to defeat what looked at first like victory. 
And to the disaster of disgenic heredity, which we sought to 
prevent, is added the tragedy of illegitimacy. 

Second, there are those who enter upon marriage, notwith- 
standing our hope that racial conscience would prevail. The 
disgenic factor may be tuberculosis, psychopathic or neuro- 
pathic instability, some higher and less obvious form of mental 
deficiency, venereal infection, or one of many other unfortunate 
defects. How can this family be prevented from becoming a 
racial menace? 

(1) Shall it be dissolved? Perhaps it is a union founded 
upon rare fineness of interest, where there is present every ele- 
ment for the better association of two responsible individuals. 
Society would hesitate, indeed, to disrupt such a family, and is 
it not possible that society would have much to lose by such 
disruption? 

(2) Shall absolute continence be imposed, if so, how and 
with what results? 

(3) ) Shall parenthood be risked by chance that amounts to 
negative compulsion or 

(4) Shall there be made possible to the members of this 
union immunity from disgenic parenthood, through control of 
conception by information which we know exists today? 

These are the phases of the problem of Birth Control as it 
relates to the individual family. How overwhelming the prob- 
lem in the field of social relationships at large! From the 
well-known Studies of the Children's Bureau, the Report and 
Evidence of the National Birth-rate Commission of Great Brit- 
ain, the statistical publications of organizations conversant 
with nation and state-wide problems of social pathology, and 
the case records of countless social service agencies, we see 
something of the panorama of tragedy in society at large. 

Is it true we have defective children doomed to defect from 



80 SECOND SESSION 

the moment of conception? Dependent and delinquent chil- 
dren and adults strongly predisposed to pathologic careers, 
not by environment alone, but by congenital defect, effective 
both by heredity and other channels of transmission? Chil- 
dren conceived of parents suffering from tuberculosis, psycho- 
pathic and neuropathic instability or veneral infection, when 
we are more certain than uncertain that these defects, or that 
predisposition to them is transmissible in many cases? Is it 
not true that children continue to be born against the judg- 
ment and will of parents, to augment the problem of relief 
and to increase the number of persons already destined to the 
humiliation of dependency upon others? And is it not true 
that many of these children will pay for their intrusion the 
penalty of early labor? 

Is it true that women, many times mothers in the midst of 
squalor, are seeking the knowledge by which they may cease 
to burden themselves and society and impair the race? That 
these mothers upon being refused this knowledge by those 
professions to whom they look for advice in other vital matters, 
resort to such modes of self-help as only frenzied minds 
can conjure up? Is it true that entire neighborhoods of 
mothers succumb to horrible remedy because prevention is 
denied them? And all this in an age of the glorification of 
motherhood, and the existence, — we may be permitted to as- 
sume, — of knowledge sufficiently ethical, aesthetic and physi- 
cally non-injurious to receive the approval of the most exact- 
ing classes of our society today! 

Can it be that the menace of extending information is 
greater than the menace of withholding it? Is it physically 
possible that the danger from abuse of knowledge can exceed 
the danger from abuse of ignorance? 

Are these not the conditions among enlightened peoples 
after race-long attempts at relief and decades of modern pre- 
ventive effort for social welfare? Excellent, searching and 
systematic as our social work has become, does it sometimes 
seem to us (especially those among us who are in the midst 
of it), that our progress lies not so much in the solution of 



BIRTH CONTROL 81 

our problems, as in the elaboration of more magnificent ma- 
chinery for their perpetuation upon an ever-increasing scale? 
And still is it not true that the human nature with which w* 
deal today with such imperfect understanding is essentially 
the same that it has always been, for after all, has it not re- 
mained remarkably unchanging? 

Where lies the inadequacy, if not failure, of our past effort? 
Is it possible that we have omitted from our plan of action 
some vitally important factor of solution? If we seem to 
possess too much reason to be purely instinctive, and too much 
instinct to be purely rational, can we not harmonize these 
endowments, and do so openly, honestly and healthfully. Have 
we made available to mankind every poiver at his command 
for self-rehabilitation? Is it possible that the power to regu- 
late parenthood by control of conception is one great resource 
upon which we have not yet drawn in our general programs 
for social welfare? 

"What is the social and racial value of Birth Control?" We 
ask this question in a scientific and impartial spirit. To whom 
may we turn for a scientific and impartial answer? 

First, shall we turn to the profession of Medicine? Or is it 
true that by force of circumstances this has become an emi- 
nently conservative body? Perhaps this is due to the suppres- 
sion which it has experienced from the days of the seven- 
teenth century, when it was compelled to conform to the 
censorship of church and state. And just as it accepted three 
centuries ago the limitations imposed upon it by the dogma of 
a distorted Aristotle, does it not consent today, with remark- 
able loyalty, to the legal restrictions initiated by a somewhat 
less notable authority, who did not have the distinction of 
possessing all the knowledge of his time? When our federal 
and state laws confer upon the Medical Profession the neces- 
sary freedom to develop the vital subjects of sex science and 
obstetrical practice, may we not confidently trust it to measure 
up to the excellent progress it has made in other fields where 
it has been free from legal limitations? 

Second, shall we turn to the profession of Social Service? 



82 SECOND SESSION 

Or is it also by force of circumstances an unfree body? Is it 
true that public charities are sometimes dominated directly 
by partisan motives and considerations of tenure that render 
scientific initiative hazardous and unwelcome? And ulti- 
mately, by an electorate whose chief recommendation is not 
its social wisdom? And is it also true that private charities 
depend for their very life upon approval of subscribers, and 
that all plans of action must proceed with utmost circum- 
spection? 

Does it seem, then, that the two great professions most in- 
timately serving human nature are among the most unfree in 
helping it to answer a fundamental question? And does it 
seem that, in comparison with these professions science is 
relatively free from the barriers of tradition and the menace 
of partisan and personal prejudice? And with this rare free- 
dom, what more magnificent work lies before you of scientific 
training and interests for scientific development and impartial 
conclusion? 

If there are any among us who discover in ourselves, from 
any motive whatever, a cringing timid circumspection which 
commends itself to us by any name of less contempt, let us 
eradicate it at once, or cease to impede and discredit the work 
of scientific endeavor. Fear and the scientific spirit cannot 
exist together. Servility and honor are incompatible. 

May I close with the entreaty that we may all consider it our 
responsibility and privilege to carry forward as rapidly as 
possible such researches as may enlighten present thought 
upon this burning present problem; if the spirit of the race 
could speak as the spirit of many an individual has spoken, 
would it ask for charity, or would it ask for justice? 

THE POPULATION QUESTION AS ILLUSTRATED 

BY ASIA 

By J. 0. P. Bland 

1MUST ask your indulgence for not having prepared a 
paper such as those to which you have listened. I must 
ask you to excuse me for not having done so, on the ground 



BIRTH CONTROL 83 

that I am only here a few days and am leaving for England 
tomorrow, and such few remarks as I can put before you are 
necessarily brief and not at all closely reasoned. 

The whole question of Birth Control, it seems to me, and 
looking at this meeting today I am more convinced, is the 
great question of the immediate future. I think in ten years 
time it is absolutely certain that a great many of the econo- 
mists and the religious bodies of the world will realize that 
the only means to prevent poverty and prostitution and crime 
and war, is by the conscientious application of collective wis- 
dom and intelligence of human beings to make their population 
in some way consistent with the food supply of their country. 
I look forward and see a tree of human wisdom whose fruit 
shall make for the peace of the world and the happiness of 
mankind. 

At the same time, I think it is quite obvious that we have 
to pierce the darkness in high places. I remember a few 
years ago the Bishop of London deplored the declining birth 
rate of Great Britain, and wished for the glorious fertility of 
the East. Last night I received a statement from a friend in 
London, which contains a curious fact in connection with the 
remark of the Bishop of London, and that is, that the lowest 
birth rate in Great Britain today is: first, of the school 
teacher; second, of the doctor; and third, of the non-conform- 
ist and other religious clergymen. 

I think it is a matter for very serious consideration. It 
is, I think, a very serious thing for us to consider, how 
it comes about that those views can be expressed today; and 
another thing, that a Conference such as meets in Washington 
today can ignore the fundamental fact, the war's cause. 

How are we going to explain this curious fact, which for 
instance they explain in a manner which does not explain in 
England. They assume there is a blind spot. How is it that 
the human intelligence which has dominated its environment 
so splendidly in other directions, cannot master this? I be- 
lieve that collective intelligence will rise superior to this and 
I regard this meeting as a proof of it. 



84 SECOND SESSION 

But to return to "the glorious fertility" of the East. It has 
been my lot to live for thirty years where I saw it working 
out. When as a young man I first went to the city of Canton, 
I used to row around on the river, and I saw the fertility of 
the east floating around near me in the shape of little corpses. 
The social system which produced that has also produced a 
very splendid civilization which is China today. It is China 
which today offers you a spectacle of a race which has solved 
the problem of population. It is solved by the doctrine or 
creed of passive resistance. The Chinese tell us when they 
have reared a population which they cannot feed, they do not 
look over their frontiers and see where they can seize on the 
means of supporting themselves. They have accepted the des- 
tinies of man and they recognize that suffering is the lot of 
every human being. And therefore the Chinese decrease in 
population has been through disease and famine and internal 
strife. Look over the history of the great people of China. 
Take the history of the last thousand years, and one fact 
stands out. The population reaches to about 350 to 400 mil- 
lions. When it reaches that point, invariably there occurs one 
of those three things which check the population. Either 
there is internal strife, or a famine breaks out which kills 
millions of them, or lastly there is disease. The religion of 
the Chinese makes it incumbent upon the Chinese to marry 
young and leave behind him as many little descendants as 
possible. It is his duty and he fulfills it to the utmost. There 
are four generations born in China while three are born in 
Europe. You get conditions such as Europe has not dreamed 
of and such as America cannot imagine. Such conditions pro- 
duce a terrible death rate. There are no vital statistics in 
China, but in Hong Kong we have kept them. We know the 
death rate varies with the harvest and disease. It is 70 to 80 
per thousand. 

I will ask you to consider another fact. We Christians 
are pleased to regard ourselves in our material and industrial 
civilization as the last word in progress, and we send mis- 
sionaries to this country, and among the duties of these 



BIRTH CONTROL 85 

missionaries is the highly meritorious work of the medi- 
cal missionary. But it has always been inconceivable to me 
that those missionaries can go to China to relieve suffering and 
leave untouched the fundamental cause of the suffering. 

Three years ago there was a mission sent out from the 
United States, which spent, I think, a million and a half dol- 
lars, and they went to China and proclaimed, in the papers of 
this country and over there, their intention of their so de- 
creasing the mortality that they would in a few years increase 
the population by over a million. It seems to me that if we 
inspect the fact that the social system of the Chinese has 
lasted for so long, has produced such excellent results, a 
superior economic man, and a kind, gentle philosopher, we 
have got to see that we do nothing to upset that culture, and 
we should only try to remove those causes of misery which are 
so obvious to us and a disgrace to human intelligence. That 
our missionaries should go to China and relieve suffering is 
splendid, but at the same time it should be brought home to 
the Chinese not to bring into this world a child who is fore- 
doomed to misery. We know the main facts about China. 
We know that people suffer patiently. We pay instinctive 
reverence to what has been brought about by suffering. It is 
a great problem, we know, seeing Nature fulfilling itself 
through the many centuries in this way, and suffering and 
producing a nation like the Chinese, it is a problem whether 
we have the right to interfere with Nature. But I think that 
those of us who look forward with hope and belief in the 
future of the human race are not prepared to accept it, and 
even advise our older brother to change his habits and 
even change his ancient beliefs in a matter that affects the 
whole of humanity. 

DISCUSSION 

Mrs. Donald R. Hooker in the chair 

Mr. Merchant (of New York) : I was impressed with what 

Dr. Johnson said. I was not here this morning, but seven years 

ago I became a foreman in a candy box factory. Before that 



86 SECOND SESSION 

time I had believed that nearly everybody was equal, or people 
were practically all equal. I don't believe that all men or all 
women are created free and equal, and in that factory that was 
impressed on me very forcibly. Thousands and thousands of 
men and women are employed there. They have three crews, 
you might say — one coming, and one working and one going. 
Of those people I don't believe that there is one person in a 
thousand that is really fit. We speak about being mentally 
fit. What is worse with the working class, or I might say, with 
the lower class, or I expect even with the upper class, what is 
worse is that people are not physically fit. They have not a 
physical education. The working class not only have not a men- 
tal education, they have not a physical education, and I don't 
believe it is possible to give them a physical education, not to 
speak of mental education. I believe that a physical education 
is more essential than a mental education. 

I watch children in the street and I see there is a potentiality 
for something great in the child, in the little fellow, but by the 
time the child is fifteen years old, he has lost nearly all of his 
essential usefulness. Why is it? I don't know. I think that 
it is natural for him to lose it. I believe most of mankind are 
naturally unfit, and under the best of circumstances cannot 
rise even though they have the best environment. I don't 
believe they can possibly rise, and in our population it is the 
lowest people, the people that are the least fit, that are giving 
us our great flood of humanity, and the people who are really 
fit in the world are those that are having no children. And if 
you are interested in mankind — I have been so depressed my- 
self that I am no longer interested in mankind. I am interested 
more in myself, because I feel that humanity is lost, utterly 
lost. The most of mankind are not good even for slaves. It is 
a terrible thing to think of men and women, but with all that 
I believe in Birth Control, and I believe the chairman said that 
she believed in making it scientific and respectable and for- 
cible. Well, I believe in the last, making it forcible. I don't 
care whether it is scientific or respectable. 

Dr. Sachs: I believe such discussion should be taking place 



BIRTH CONTROL 87 

at local meetings. When we come here big subjects should be 
talked about. The previous speaker said something about in- 
telligence and the country children, and the intelligence of the 
city children. He said the country children are far inferior to 
the city children. I have a little family of my own, and we 
discuss the political situation and the vote, and they said "You 
take a boy in the country, he knows all about the country." I 
said "Your boys come back from work, what are they talking 
about ? There is a fight there, or in the summer they talk about 
baseball and so on." Absolutely no sense to that. No brain 
matter. Now of course you take the children in the country. 
The country children have more time to study. Probably it 
is the trend of modern education. The boys meet and the 
street corner and discuss sports and so on. It is not the fault 
of education. It is the fault of the system of education. I be- 
lieve myself that the country boys are smarter, and they take 
their country's welfare more to heart than the city boys. 

Dr. Konikow: Speaking about the fit and unfit, I was quite 
surprised "o hear that because a man is working in the ditches 
he is not fit. I think the question of success in our capitalistic 
world, whether a man or a woman makes a success, does not 
prove that he or she is particularly fit from the sense of the 
ideal. For conditions are such that not always the fit succeeds. 

I want to point out that I am here representing people that 
are usually considered to be not fit, that is, some of the people 
of the working class. It is the Mother's League of Boston that 
sent me here, and the members of that League are women of the 
working class and of the Boston west end — the Boston west 
end is the east side. These women are very deeply interested 
in Birth Control, and I would like to confess that if they would 
listen to the speeches of today they probably would have ob- 
jected for the simple reason they would say it is old stuff, we 
know it all. All these things have been said to us so many 
times over and over again. We don't need any proofs that 
Birth Control is needed. We women of the working class 
have heard it again and again. Don't come to us and tell us 



88 SECOND SESSION 

Birth Control is needed. Tell us how to do it. That is what 
we want. That is what I say. In all those speeches today I 
suppose no one of us learned very much of what is new, be- 
cause we all realize all the different points why Birth Control 
is important. The only really refreshing point to me was the 
promise of the biologist that if there were a strong demand, 
that the biologists should study the question, there would be a 
response. But I would tell this biologist it only shows what 
little relationship there is between science at the present time 
and real life. Why, isn't it surprising that for the last ten or 
fifteen years the question of Birth Control has been continu- 
ously discussed everywhere, and only now our scientists are 
awakening to the question that perhaps it would be useful to 
study it. You should have done it long ago. Long ago they 
should have taken up the question and really succeeded in 
doing something in that line. I think they would have de- 
served the gratitude of mankind. But that is the great question 
for us. How in the world will we succeed to provide real 
means of Birth Control if we haven't got the help of the scien- 
tists, and the scientists and the colleges refuse to give us their 
help. 

I would like to say this. Something is going on among the 
students. I would like to tell you about it now. Some of the 
Harvard students told me in Boston that they are going to 
demand from their professors some information about Birth 
Control. They say they are sick and tired to find out, when 
they graduate and go out into the world and a woman comes to 
them for information, they cannot give it to her because they 
don't know anything about it. 

One of the physicians this morning accused the medical pro- 
fession about taking no interest in this. I would defend them. 
I would say they really have no information. They really 
don't know anything about it. A good many of them would be 
very willing to give information. And as to the law which 
prevents a physician — I am physician myself and give this 
information. Why, the law is obsolete. No one pays any 
attention to it. This law would not prevent a physician from 



BIRTH CONTROL 89 

giving information if the physician really knew. You know, 
you colleagues of mine who are physicians, you who have real 
information you would give it to the patient if you really knew 
that you had some real good information; there is no doubt 
about it. There is no real information therefore the evening 
session will be a real interesting one. 

One point that is interesting to me came up, that even with 
Birth Control people, we have to go on different ways. I came 
here merely interested in Birth Control. But I have to declare 
that I feel like a stranger among you all, because with Birth 
Control you bring in again certain political moves that are 
entirely of no interest to me. You are sending a telegram to 
Washington. All that is going on in Washington is nothing 
else than a comedy, something of no importance at all. I 
think that Washington will never solve the question of dis- 
armament. I want to express that neither will Birth Control 
nor what is going on in Washington settle the question of 
poverty, war and all these other great problems. As long as 
there is imperialism and capitalism we will never solve the 
question of poverty or the question of stopping war. I want 
to tell you that there is a bourgeois movement and a working 
class movement of Birth Control. The working class move- 
ment of Birth Control would not send a telegram to Wash- 
ington. But as far as the movement of Birth Control is con- 
cerned, I am with you. I am interested in a scientific in- 
vestigation of the subject. 

Dr. Flanagan: I simply want to congratulate the manage- 
ment of this organization and this meeting upon the high class 
of the papers which have been read here this afternoon. Every 
one of them has been of extremely high scientific order. 
There is one thing that has impressed me in hearing these 
papers read, and that is, that we have not yet sufficient statistical 
information upon which to base our conclusions. Now, I am a 
statistician and I became so because of my interest in studying 
sociological problems, particularly the race question, and I am 
interested in assisting anyone who desires the compilation of 
just such facts. Now, I will say, that we are not yet getting 



90 SECOND SESSION 

those statistics from the United States Bureau of Census. They 
have only recently begun the registration of births and the 
studying of the question. 

In 1917 the first statistics were published for the New Eng- 
land states, New York, New Jersey and Pennsylvania, and 
one or two other western states. Since then two or three 
southern states have gotten on. Virginia was the first to get on 
and Kentucky, South Carolina and North Carolina, and several 
others, are coming on. 

There is where a very important problem is presented. The 
question has not been studied thoroughly from a staListical 
standpoint. I want to offer you my assistance in this matter. 
If you want to learn any question with reference to legitimacy, 
the size of the family, and questions of that sort, I shall be 
glad to be of service to you. Next week I will be here to 
attend the American Public Health Association conference, the 
vital statistics section, and it is possible for that question to be 
presented and to be handled more thoroughly throughout the 
country than it is now. 

I want to refer to the classical paper that was read by Miss 
Young on delinquency; especially to the question of legitimacy. 
That is one that has not been studied thoroughly. The question 
of Birth Control of those who are professional courtesans, I 
don't think that enters, because we know that they soon become 
infected with venereal diseases. The question settles itself. 
They don't have children, whether they try to prevent it or not. 
We have this in Virginia. In Virginia we had last year about 
3,300 illegitimate births. That is, of unmarried women, 
and most between the ages of 15 to 20, around there. The 
first children. And of course a very large per cent, are colored. 

That is the problem. How are we going to stop that? And 
any means that you can devise at all to solve that question will 
be one of the most interesting things that you can undertake, 
and as I said this morning, I came here to learn. 

The Chairman: I am going to call upon Mrs. Sanger to 
sum up our day's work. 

Mrs. Sanger: Madam Chairman, and friends. It seems to 



BIRTH CONTROL 91 

me in listening to the papers, that I thoroughly agree with the 
last speaker, Dr. Flanagan from Virginia, that the papers have 
been excellent, in a very splendid key. It seems to me that 
they have been of sufficient variety to bring in and to show all 
of us today how wide the subject of Birth Control is, and how 
important it is to include it into practically every program that 
we have for racial betterment and for national health. 

There is one thing that I feel has perhaps not been under- 
stood. One of the speakers in one of the very able papers 
spoke of the emotional, and told us to take principles out from 
the emotional, and I just want to call attention, whenever any- 
body says "emotional" in Birth Control, I know they mean me. 
I want to say this. That when you realize that six or ten years 
back the same conditions were there as are here today, the same 
kinds of people, the same abortions, the same working con- 
ditions, the same overcrowding conditions, and yet it w^ould 
have been impossible to have gathered together a group such 
as is here today to discuss this subject. Everywhere you looked 
people said "Yes, that is important. But don't talk about it." 
And it was necessary for some one to come out and waken an 
inert people. You could not do it at that time by reasoned or 
logical discussion. I always said that when the house is on 
fire you don't criticize the voice that calls your attention to it. 
It may not be ladylike, and just the tone and quality of voice 
we would like to hear, nevertheless we are glad that that voice 
has aroused our attention to the fact that the house is on fire. 
Now, in planning to awaken an inert people to the importance 
of Birth Control, I felt that it was first necessary to agitate and 
to awaken their interest in the question. There had to be 
various means and methods. The first thing was the challeng- 
ing of these laws that have been for more than one hundred 
years upon our statute books. We hold the law as a rather 
sacred thing, and the only way you can awaken people to the 
question that was here before us, was to challenge that thing 
which all of us held sacred. That arouses attention, and when 
this is done, then we come to plan the means of giving the mes- 
sage and of educating. So the process goes, agitate, educate, 



92 SECOND SESSION 

organize and legislate. We are now up to our third stage, of 
organization. 

Now, all of us know, as I do, having been a nurse for many 
years among all kinds of people, that while some people had 
knowledge to prevent conception, thousands of others did not 
have it, that the reason was not only the ignorance of the 
people themselves, but also the lack of attention or the lack of 
knowledge of the medical profession. I found that most 
physicians who were honest with me said "Well, there is very 
little that I know about it." So we had to arouse their interest 
as well, and I tliink that the victory of this agitation, of this 
education, is in the meeting that we are holding tonight, I sup- 
pose it is the first meeting of the kind that has been held in the 
United States, where we are to discuss the ways and means to 
prevent conception. We have been overwhelmed with requests 
for these tickets. I assure you it is most pleasing. We have 
also had a great many requests from the nurses and social 
workers to attend that session, and we regret to say that we 
are unable to accommodate them tonight because so many 
physicians have applied for admission. Now out of this con- 
ference tonight I believe we will begin to get somewhere, and 
if, as Dr. Konikow stated, there has been nothing new at this 
meeting, she must speak for herself, because I think there are 
many of us who have found new suggestions, new ideas. And 
even if they have not been new, we have been convinced once 
more of the strength of our own ideas. So I feel that all of 
us must feel today a strengthening of our conviction that Birth 
Control is absolutely an essential part of the program from 
every angle and from every platform that we have to put into 
operation to make this a better country and a better race. 

The Chairman (Mrs. Hooker) : Mrs. Sanger has again, I 
think, given us a keynote, that after all while we sit here and 
discuss in some academic manner this matter of Birth Control, 
what it really sums up to is this, that we realize that from this 
meeting tonight we may get information, we may get organ- 
ization, which may work towards the perfection of human life, 
which may save much needless suffering. We must realize that 



BIRTH CONTROL 93 

whether we ourselves have gained much or not, we at least have 
contributed much. 

Secondly, what has been brought out over and above ctll 
today is that there is no question but that sex hereafter in this 
after country is to be considered in a rational way. From sex 
arises our very life. From sex may come the greatest happi- 
ness, the greatest nobility that life can ever create. It is non- 
sense and it is altogether out of date for people to put a taboo 
on the discussion of sex subjects. I think we have at last grown 
up and it is one of the reasons that we can meet together in 
conferences of this sort and gain so much for our own and our 
country's welfare. 

[Adjournment] 



SESSION III. 

SATURDAY, NOVEMBER 12, 1921, 9:30 A. M. 

Mrs. Edith Houghton Hooker, Chairman 

The Chairman: We left for this morning the consideration 

of a telegram which was to be sent to Washington, and we will 

inaugurate the session with reading of the telegram as prepared 

by the committee: 

"To the distinguished statesmen of the Washington 
armament conference. We, assembled at the First 
American Birth Control Conference, send greetings 
and suggest a thorough consideration of the adjust- 
ment of the world's population to the means of sub- 
sistence as a fundamental solution of the world's 
peace and a necessary basis for national growth and 
international progress." 

Motion to send telegram carried. 

POPULATION PROBLEMS IN ASIA 
By Lothrop Stoddard 

OF ALL earth's regions cursed by the blight of over- 
population, Asia stands forth as the "horrible example." 
For ages the teeming populations of the East have been pro- 
verbial. Today Asia contains not less than 900,000,000 
people, while China and India are the two greatest human 
hives the world has ever known. These Asiatic societies dis- 
play the melancholy corollaries of over-population: congestion, 
low living-standards, and the prevalence of cruel "natural" 
checks on increase like famine and disease. 

However, these stern lessons of Mother Nature seem thus 
far to have taught the Asiatic nothing. Generation after 
generation he has gone on blindly breeding beyond the limits 
of available subsistence. Save for a very few and very recent 
pioneer efforts (to be discussed later) Asia has even not con- 

94 



BIRTH CONTROL 95 

sidered the idea of Birth Control. In fact, the whole social and 
religious atmosphere of the Orient favors reckless procreation 
and is hostile to the concept of voluntary limitation of births. 
It would be a mistake to ascribe Oriental fecundity solely to 
climate or strong sexual appetites. These, of course, play 
their part; but they are powerfully re-enforced by economic 
reasons like the harsh exploitation of women and children, by 
social reasons like female subjection, and perhaps most of all 
by religious doctrines enjoining early marriage and the be- 
getting of numerous sons. The upshot has been, as already 
stated, chronic over-population. 

In the past, to be sure, Asia's over-population was more or 
less a local issue, its evil consequences, however painful, being 
confined to the Asiatic peoples themselves. Indeed, these evils 
never went beyond a certain intensity, because population- 
pressure was continually and automatically lightened by fac- 
tors like war, misgovernment, pestilence, and famine, which 
constantly swept off such multitudes of people that, despite 
high birth rates, population remained substantially at a fixed 
level. 

During the past century, however, the situation has radically 
altered. Most of Asia has fallen under European political 
control, and Western colonial government has meant the put- 
ting down of internal war, the diminution of governmental 
abuses, the decrease of disease, and the lessening of the blight 
of famine. In other words, those "natural" checks which pre- 
viously kept down Asiatic populations have been diminished 
or abolished, and in response to the life-saving activities of the 
West, the enormous death-rate which in the past has kept 
Oriental populations from excessive multiplication is falling 
to proportions comparable with the low death-rate of Western 
nations. But to lower the Orient's prodigious birth-rate is 
quite another matter. As a matter of fact, that birth-rate keeps 
up with undiminishing vigor, and the consequence has been a 
portentous increase of population in nearly every portion of 
the Orient under Western political control. In fact, even those 
Oriental countries which have maintained their independence 



96 THIRD SESSION 

have more or less adopted Western life-conserving methods, 
and have experienced in greater or less degree an acclerated 
increase of population. This is notably true of Japan. 

Japan and India are, in fact the two countries where Asia's 
problem of increasing congestion are best exemplified. China, 
the greatest human ganglion of them all, is still so much 
affected by natural checks (famine, pestilence, misgovernment, 
etc.) that her teeming population, estimated at from 325,000,000 
to 450,000,000, seems to keep at about a stationary level. That 
China's population would, however, shoot upward by leaps 
and bounds if those natural checks were removed cannot be 
doubted. For example; one of China's provinces was almost 
depopulated during the great Taiping Rebellion of half a 
century ago. Yet within twenty years the gaps had been 
practically filled, and in the recent famine this province was 
so over-populated that it was one of the worst sufferers. 

The story of Japan's recent growth in population is most 
significant. During the long centuries of her isolation from 
the outer world, Japan's population remained at a virtually 
constant level. The limits of subsistence under the then exist- 
ing conditions having been reached, further increase was pre- 
vented by natural checks such as internecine war, the preva- 
lence of epidemics, and, in certain sections, by the practice 
of infanticide. When Japan emerged from her isolation about 
the middle of the last century, her population was about 
27,000,000 — only 900,000 in excess of what it had been a cen- 
tury and a half before. But no sooner had modern ideas like 
sanitation and efl&cient government been introduced than a 
momentous increase of population ensued. By 1872, the 
population had risen to 33,000,000; in 1898 it had risen to 
44,000,000; while the census of 1920 gave approximately 
56,000,000. Thus, in about half a century, Japan's population 
had more than doubled, while an analysis of the various cen- 
suses shows that this increase has been cumulative, the birth- 
rate rising steadily, the death-rate falling rapidly, and the net 
increase showing no signs of decline. 
The result has been, of course, acute congestion. Japan 



BIRTH CONTROL 97 

is a poor country. Her total area is less than that of the state 
of California, while most of her territory is mountainous and 
unfit for cullivation. So great is the congestion in the rela- 
tively small productive areas that therein the density of pop- 
ulation has been recently estimated at 2,688 per square mile 
— more than four times the density of Belgium, the most 
densely populated country of Europe. 

As for India, the story is strikingly similar. At the be- 
ginning of the Nineteenth century, the population of India is 
roughly estimated to have been 100,000,000. Even at that 
time the country was considered to have been over-populated. 
Yet the result of a century of British rule has been a further 
increase (in 1911) to 315,000,000. In other words, the Indian 
people have employed the material benefits of British rule, 
not to raise their living standards, but to breed right up to 
new margin of subsistence until they are as badly off as before 
(perhaps worse off). And the most discouraging feature of 
the situation is that Indian public opinion shows virtually no 
recognition of the matter, ascribing their misfortunes almost 
exclusively to political factors, especially European political 
control. In fact, the only case that I know of where an Indian 
thinker has bodily faced the problem and has courageously 
advocated Birth Control is in the book published five years 
ago by P. K. Wattal, a native official of the Indian Finance 
Department, entitled The Population Problem in India. This 
pioneer volume is written with such ability and is of such 
apparent significance as an indication of the awakening of at 
least a few Indians to a more rational attitude, that it merits 
specil attention. 

Mr. Wattal begins his book by a plea to his fellow country- 
men to look at the problem rationally and without prejudice. 
"This essay," he says, "should not be construed into an attack 
on the spiritual civilization of our country, or even indirectly 
into a glorification of the materialism of the West. The object 
in view is that we should take a somewhat more matter-of-fact 
view of the main problem of life, viz., how to live in this world. 
We are a poor people; the fact is indisputable. Our poverty, 



98 THIRD SESSION 

is, perhaps, due to a great many causes. But I put it to every 
one of us whether he has not at some of the most momentous 
periods of his life been handicapped by having to support a 
large family, and whether this encumbrance has not seriously 
affected the chances of advancement warranted by early prom- 
ise and exceptional endowment. This question should be 
viewed by itself. It is a physical fact, and has nothing to do 
with political environment or religious obligation. If we 
have suffered from the consequences of that mistake, is it not 
a duty that we owe ourselves and to our progeny that its evil 
effects shall be mitigated as far as possible? There is no 
greater curse than poverty — I say this with due respect to our 
spiritualism." 

After this appeal to reason in his readers, Mr. Wattal de- 
velops his thesis. The first prime cause of over-population in 
India, he asserts, is early marriage. Contrary to Western lands, 
where population is kept down by prudential marriages and 
by Birth Control, "for the Hindus marriage is a sacrament 
which must be performed, regardless of the fitness of the 
parties to bear the responsibilities of a mated existence. A 
Hindu male must marry and beget children — sons if you please 
— to perform his funeral rites lest his spirit wander uneasily 
in the waste places of the earth. The very name of son "putra," 
means one who saves his father's soul from the hell called Puta. 
A Hindu maiden unmarried at puberty is a source of social 
obloquy to her family and of damnation to her ancestors. 
Among the Mohammedans, who are not handicapped by such 
penalties, the married state is equally common, partly owing 
to Hindu example and partly to the general conditions of 
primitive society, where a wife is almost a necessity both as 
a domestic drudge and as a helpmate in field work." The 
worst of the matter is that, despite the efforts of social 
reformers, child-marriage seems to be increasing. The census 
of 1911 showed that during the decade 1901-10 the numbers 
of married females per 1,000 of ages 0-5 years rose from 13 to 
14; of ages 5-10 years from 102 to 105; of 10-15 years from 
423 to 430; and of 15-20 years from 770 to 800. In other 



BIRTH CONTROL 99 

words, in the year 1911, out of every 1,000 Indian girls, over 
one-tenth were married before they were 10 years old, nearly 
one-half before they were 15, and four-fifths before they were 20. 

The result of all this is a tremendous birth-rate, but is "no 
matter for congratulation. We have heard so often of our 
high death-rate and the means for combating it, but can it be 
seriously believed that with a birth-rate of 30 per 1,000 it is 
possible to go on with the death-rate brought down to the 
level of England or Scotland? Is there room enough in the 
country for the population to increase as fast as 20 per 1,000 
every year? We are paying the inevitable penalty of bringing 
into this world more persons than can be properly cared for, 
and therefore if we wish fewer deaths to occur in this country 
the births must be reduced to the level of the countries where 
the death-rate is low. It is, therefore, our high birth-rate that 
is the social danger; the high death-rate, however regreltable, 
is merely an incident of our high birth-rate." 

Mr. Wattal then describes the cruel items in India's death- 
rate: the tremendous female mortality due largely to too early 
childbirth, and the equally terrible infant mortality, nearly 
50 per cent, of infant deaths being due to premature birth or 
debility at birth. These are the inevitable penalties of early 
and universal marriage. For, in India, "everybody marries, 
fit or unfit, and is a parent at the earliest possible age per- 
mitted by nature." This process is highly disgenic; it is 
plainly lowering the quality and sapping the vigor of the race. 
It is the lower elements of the population, the negroid aborig- 
inal tribes and the pariahs or outcasts, who are gaining the 
fastest. Also the vitality of the whole population seems to be 
lowering. The census figures show that the number of elderly 
persons is decreasing, and that the average statistical expecta- 
tion of life is falling. And unless Indian public opinion 
speedily awakens to tfie situation, the evils just described will 
go one with ever increasing intensity. 

Such is the warning thesis of Mr. Wattal's book. It should 
be remarked that he does note a few dim fore-shadowings of 
Birth Control in India. For example, he quotes from the 



100 THIRD SESSION 

census report for 1911 this official explanation of a slight 
drop in the birth-rate of Bengal : "The deliberate avoidance of 
child-bearing must be partly responsible ... It is a matter of 
common belief that among the tea-garden coolies of Assam 
means are frequently taken to prevent conception, or to procure 
abortion." And the report of the Sanitary Commissioner of 
Assam for 1913 states: "An important factor in producing 
the defective birth-rate appears to be due to voluntary limita- 
tion of births." 

However, these beginnings of Birth Control are too local 
and partial to afford any immediate relief to India's growing 
over-population, and Mr. Wattal himself is not very hopeful 
of a rapid breaking down of the traditional factors favoring 
reckless procreation. 

In Japan, as in India, the beginnings of a Birth Control 
movement have appeared. In fact, the Japanese Government 
is investigating the problem, and within the past year a num- 
ber of representatives of the Ministry of the Interior have been 
travelling through America and Europe, studying conditions 
and formulating reports on how Birth Control may be applied 
to Japan. In Japan, however, the Birth Control movement is 
bitterly opposed by the militarist and imperialist elements who 
still sway Japan's political life. To them increasing congestion 
is the best argument for their policies. A vast human surplus 
is the ideal material for rapid colonization, for a desperate 
nationalism ready for risky ventures, and for abundant cannon- 
fodder in the wars which aggressive foreign policies may bring 
about. 

Thus throughout the vast continent of Asia, there is occurring 
a race between procreation and Birth Control: a race mo- 
mentous, not merely for Asia, but for the whole world, since 
upon its outcome world-peace or world-ruin may depend. And 
let us face facts bravely — the omens for world peace are not 
bright. It is true that a conscious Birth Control movement 
has started in Asia's most advanced portions — India and Japan, 
— and that we may hope for its rapid spread in the near future. 
It is true that the rapid rise in living costs and living standards 



BIRTH CONTROL 101 

throughout the East must involve conscious or unconscious 
checks on the growth of population. Lastly, the industri- 
alization of many parts of the Orient will afford a livelihood 
to many millions of persons. 

But these limiting factors, however potent they may ulti- 
mately become, cannot at once counteract the factors making 
for excessive multiplication. Apprently, for the next genera- 
tion at least, Asia is going to keep on piling up excess people. 
And this, in turn, means an increasingly prodigious outward 
thrust of surplus Asiatics from congested centers toward 
regions emptier, richer, or with higher standards of living. 
But will these emigrants be admitted? To the emptier parts 
of Asia, perhaps. To Western lands like America, Australia 
and Canada assuredly no. 

Here is a problem which only Asia can solve, by raising 
her living-standards and by rational Birth Control. Asia can- 
not expect any Western nation to jeopardize its whole social 
and racial future by becoming a dumping ground for Asia's 
boundless spawning. Some Asiatics, alive to the realities of 
the situation, recognize the truth of this. Mr. Wattal, for 
example, warns his fellow countrymen that they cannot hope 
to shift their human surplus to other lands; while only a fort- 
night ago the well-known Japanese liberal, Yukio Ozaki, said 
in a public address: "Some Japanese insist upon the open 
door principle in the Pacific generally, including the other 
side of the ocean, to facilitate the solution of the emigration 
question. They must be reminded that this policy during 
twenty years has been advocated in a commercial sense alone. 
The emigration question is serious, no doubt, but it should 
not outweigh consideration for other nations' convenience and 
rights — circumstances which could easily be realized by assum- 
ing an influx, for instance, of Indians into this country. Japan 
ought to be grateful to the Powers for their sympathy in the 
matter of surplus population, but we should not forget that 
this requires solution from within. There is nothing to be 
proud of in causing a nuisance to others through failure to 
control population." 



102 THIRD SESSION 

Some Asiatics thus see things clearly. Theirs is the spirit 
which, if it prevails, v/ill get Asia peacefully over the critical 
period, now upon her; the critical period between the advent 
of a civilized death-rate and a civilized birth-rate; between the 
laying of drain pipes and the practice of Birth Control. 

But will this spirit prevail? Will the voice of liberal under- 
standing persuade hungry myriads or silence the sinister 
harangues of designing militarists and ignorant demagogues? 
On the answer to that question hangs peace or war. As Pro- 
fessor Ross well says: "The real enemy of the dove of peace 
is not the eagle of pride nor the vulture of greed but the stork!" 

BIRTH CONTROL AND INFANT MORTALITY: 

AN ECONOMIC PROBLEM 

By James Maurer 

President, Pennsylvania Federation of Labor, Harrisburg, Pa. 

DURING the early history of this Republic, it was quite 
fashionable, in fact, patriotic, to have large families. 
The head of the family wanted plenty of children with 
which to work the farm. Fixing the minority age at twenty- 
one years, gave parents the right to exploit their offspring until 
they arrived at their majority. Another incentive for big fam- 
ilies was the new world needed people so much that the birth 
of a child was looked upon, not only as a family asset, but a 
patriotic contribution to the Nation. The larger the family, 
in those days, the greater the opportunity for the head of the 
family to pay off the mortgage and get rich. Indeed, families 
with only five or six children were not considered big. Nine 
and ten children were looked upon as the average family. To 
boast of being the father of a big family, it was necessary to 
have from twelve to eighteen children and, to accomplish this, 
it was often necessary to send two or three wives to their 
graves. Indeed, it is seldom that living mothers of such large 
families can be found. When one is discovered, it is such a 
rare exception that it attracts the attention of the scientific 
world and public ofl&cials, as in the case of Mrs. Domenico 



BIRTH CONTROL 103 

Zaccahea, of New York, a living mother of sixteen children, 
who received a letter of congratulation from President Harding. 
Great industrial changes have taken place during the past 
century. The primitive handicraft methods of production on 
the farm, gradually, gave way to machine production and 
agricultural machinery. The farm which formerly required 
a dozen people to work, can now be worked with three or four. 
The blacksmith and wheel-wright shops which were once part 
of the farm equipment have, long ago, evoluted into factories, 
mills and workshops of towns and cities. The same is true of 
the textile industry. Even butter- and cheese-making is no 
longer part of the farmer's work. As this work left the farm, 
it was quite natural that the workers should also leave. There 
was no longer any economic need for large families but, due 
to habit and religious dogma, big families continued to be 
fashionable and, while it is true that the children of the big 
family were no longer needed, the greater truth is that the farm 
could no longer support a big family, so the children, naturally, 
drifted after the jobs in the cities, there to mingle and associate 
with others who left, not only other farms, but countries, in 
search of jobs, or the privilege to do the work which once upon 
a time was done on the farm. There, under a new and strange 
environment, they hear from certain physicians, corporation- 
serving politicians, the clergy and the press, much about the 
honor and glory of raising big families and Birth Control is 
damned, not only as unpatriotic, but as an unpardonable sin. 
And of course, the having of big families goes merrily on. 
Children are poured into the world without the slightest re- 
gard for their prospects of maintenance, health or happiness. 
When on the farm and exploited by their fathers, the 
combined family earnings belonged to the family and, in 
time, through inheritance, each child received its share of 
the remaining wealth created collectively by the family. There- 
fore, from a purely monetary point of view, there really was 
little, or no exploitation. Not so, however, under the new 
order. The wage-worker of today, whether minor or adult, 
works not for the family fund which some day may revert to 



104 THIRD SESSION 

those who created it, but. on the contrary, every penny, above 
his, or her, wage, or cost of living and reproduction, goes to 
the people who own the job and not one cent ever finds its way 
back to those who created it, unless it is in the form of charity. 
It is, therefore, quite natural for those who live by exploiting 
their fellow-men, to favor the raising of big families. The 
greater the number, the easier the picking. Wages are fixed 
so that fathers cannot afford to support and educate their 
children. The children must go to work and become self- 
sustaining. This often brings the children in direct compe- 
tition with the parents who suffer wage reductions on account 
of the competition of their own children. 

Every effort to place Child Labor legislation on the statute 
books of our various States, or Nation, is vigorously opposed 
by the interests who profit either by exploiting minors directly, 
or who use children as competitive clubs to beat down the 
wages of men and women. Of course they want their victims 
to multiply, no matter how mothers may suffer and die, or 
whether some of the offspring from underfed, weak, over- 
worked, soul-racked mothers are physically, or mentally, de- 
fective. "See," cry the parasites, "we are a Christian and 
charitable people! We care for these unfortunates. We allow 
them to display their deformities on the public highways and 
beg. In the bigness of our hearts, we give some of them jobs, 
even if we don't pay them very much. We maintain an army 
of police to protect, not only ourselves, but the w^orkers as 
well, against those suffering, not only from mental defects, 
but rebellious intellects as well. We erect and maintain penal 
institutions, hospitals and lunatic asylums at an enormous 
expense to take care of these unfortunates who happen not to 
die in infancy." And in one grand chorus, the w^hole outfit 
sings, "Suffer little workers, let them come. We need them 
every hour." And yet, it may seem strange to some people that 
those who cry the loudest for big families, usually have either 
no families or very small ones, themselves. 

President Harding, who congratulated poor Mrs. Zaccahea 
because she gave birth to sixteen children, has no children 



BIRTH CONTROL 105 

of his own. In fact our three last presidents, all combined, 
had only five children, less than two to a family. Sen- 
ator Penrose doesn't have any, while the Governor of Penn- 
sylvania, I understand, has two. As a matter of fact, wealthy 
men, best able to raise large families, are either bachelors or 
fathers of small families. Medical men, statistics tell us, have 
the smallest birth-rate, while the birth-rate among the clergy 
is almost as low as it is among the medical profession. Yet 
there was a time when the clergy boasted of their large fam- 
ilies. The merchant and professional classes also have very 
low birlh-rates. We also find small families among the fairly 
well-paid, skilled mechanics. It is the poor, the unskilled, the 
poorest of the poor, we find, who have the large families, those 
who, through no fault of their own, live from hand-to-mouth, 
in rented shanties or vile, disease-breeding tenements, and who 
receive a wage scarcely big enough to decently support them- 
selves. Yet, these are the unfortunates who have the largest 
families. Tens of thousands of these mothers must, besides 
bearing the children, do all the house-work, cook, wash, sew, 
nurse the sick and, perhaps, get a job to help her husband earn 
a few dollars extra to buy bread for the hungry little mouths 
at home. May I ask, "Can such a mother give birth to a 
vigorous, healthy, normal child?" Ordinary common sense 
says, "No." Yet these are the mothers to whom present-day 
society looks for the perpetuation of the race while the well- 
to-do, the wealthy, leisure class, with no cares, comfortable 
homes and assured incomes, refuse to bear children and, in 
many cases, for no other reason than that to do so might inter- 
fere with their life of play and social ambitions. 

On the other hand, we find a great many of the pro- 
fessional and skilled mechanics raising families within their 
means. The average among this class of workers are 
desirous of giving their children every advantage in the strug- 
gle for existence possible, education, plenty of good, whole- 
some food and comfortable homes. And this is only possible 
where the size of the family is kept within the income of the 
parents and the health of the mother is carefully guarded. 



106 THIRD SESSION 

Although a Federal law prohibits the transportation of any 
information as to preventing conception and the laws of 
eighteen states, still more drastic, forbid the giving of infor- 
mation, by any means whatever, verbally or even indirectly, in 
all other states, except four, they have laws of one kind, or 
another, prohibiting birth-regulation. But all these laws seem 
to be "dead letters" in so far as the rich, or middle class, is 
concerned. The size of their families proves that these more 
fortunate members of society can, and do, get the information 
and, most likely, from their family physicians which, of course, 
is the proper place to get it. But the poor, without influence or 
money, who need the information most, cannot get it and, as a 
result, may resort to abortion, amateurish, dangerous, bungling 
operations. 

Almost every young married couple, no matter how poor 
they may be, dream of a cozy home and children of their own. 
The stork's first visit brings joy and the bond of matrimony is 
welded tighter when the baby that is wanted, comes. How 
proud the parents are and what dreams both have of the future 
possibilities of their child! Before baby can walk, or talk, the 
stork comes again, this time, not with a baby that is really 
wanted, but with one that is welcome just the same. And so, 
a third, fourth and fifth, in rapid succession, come. While the 
parents love them all, the last arrivals were not wanted. The 
happy, plump, rosy-cheeked bride of a few years ago is now 
a thin, pale and haggard-looking woman. There was not 
enough rest for the mother between each birth. As a matter 
of fact, her responsibilities, household duties and labors in- 
creased as her body was drained and her vitality decreased. 

In the meantime, the father finds the struggle to care for 
his family is becoming more difficult. His wages do not 
increase when his family does. Enforced idleness, sickness, 
increased cost of living, high rents, etc., come. His wages are 
not enough to meet the family expenses, so the growing family, 
through force of necessity, moves into a smaller, cheaper and 
less-desirable place. Unconsciously, perhaps, they also econo- 
mize on the food and, amidst their struggle to live, comes the 



BIRTH CONTROL 107 

mysterious hand of Death. The baby, born from a weak, over- 
worked, underfed mother, dies. Surely now, with one less in 
the family for which to care, the mother will soon regain her 
health. But a miscarriage blasts their hopes. Poverty does 
not permit engaging a nurse so, while the father is at work, 
ten-year-old Bobbie and eight-year-old Mary try to take care 
of Mother and baby brother and sister. True, Mrs. McGinnis, 
a kind-hearted neighbor and mother of eight children herself, 
drops in now and then to give a helping hand. 

So, time passes on, more children, not wanted, come. The 
father, growing older, finds that the pace demanded to hold his 
job is getting beyond him. The plant has been Taylorized and 
speed is what counts. The wife, a mere frame of her former 
self, sickly and disheartened, collectors everlastingly demand- 
ing payment, eviction threatened, another baby dies. Father 
and husband out of work, or working short time and, amidst 
all this hell, the stork threatens to come again. "Oh, God," 
says the mother, "why another one? We can't take care of 
those we do have and that's why they die, so why send us 
babies only to die as babies?" And many of these mothers, 
in sheer desperation, resort to abortion, sometimes without 
success, with the result that often deformed creatures are 
ushered into existence. And, if the father, different from 
many others, does not weaken and, like a coward, desert his 
family to escape the tortures of misery and poverty, and the 
mother does not die or go crazy, they may raise, to manhood 
and womanhood, some of their children, only to see their sons, 
some day perhaps, taken from them to be used for "cannon- 
fodder" to feed a war inspired by men of small families or no 
families at all. 

There may be some who think that this picture is over- 
drawn, but I assure you that it is not overdrawn. There 
are millions of such families in the United States and, in some 
of them, the conditions are far worse than those I just de- 
scribed. 

It is obvious, therefore, that the poor cannot afford large 
families. But, laying aside the question of bread and butter, 



108 THIRD SESSION 

or the hardships of parents, is it wise for a nation to depend 
upon weakened, neglected, underfed, overworked, soul-racked 
mothers for the perpetuation of the race? Is it wise to pauper- 
ize a family so that the mother may bring forth children, many 
of them to die in infancy, others to live as mental defectives 
to reproduce their kind? Is it wise? Is it just? I dare say, 
is it human to give to the world the free and unrestricted 
knowledge of how to breed animals and, at the same time, 
outlaw the science of human birth-regulation and treat as 
immoral and indecent the knowledge which surrounds the 
sacredness of human motherhood? 

The home is the place where happiness must dwell and, to 
be happy, the coming of children must be welcome, but there 
can be no happiness if the coming of children is at the sacri- 
fice of the wife's health, or life. Neither can there be happi- 
ness where the father's wage is insufficient to properly provide 
for the family. 

Government officials define a living-wage for a family of 
five at thirty-five dollars a week. We know that millions of 
fathers receive no such wage and it is usually these poorly- 
paid fathers who have the largest families. In Pennsylvania, 
a highly-developed industrial State, we find that, during the 
past four years, out of every thousand babies born, an average 
of one hundred and nine died before they were a year old. 
Compare these figures, in "no-birth-control" Pennsylvania, 
with New Zealand where family regulation is permitted and 
understood. The baby death-rate there is only fifty per thou- 
sand, as against one hundred and nine in Pennsylvania. 
Astounding and truthful as these figures are, they do, however, 
not tell the whole truth. We find that, high as the death-rate 
among babies is, it varies according to the family income. 
For instance, in Johnstown, Pennsylvania, among the em- 
ployees of the Cambria Plant of the Midvale Steel, where 
housing conditions are bad and wages low, we find the death- 
rate, among the first- and second-born, was, when the survey 
was taken, one hundred and thirty-eight per thousand, while 
the death-rate of babies under one year of age and among the 



J 



BIRTH CONTROL 109 

ninth- or later-born, was two hundred and one per thousand. 
We further find that, as wages decrease, the baby death-rate 
increases. Infant mortality, where the family income averages 
five hundred dollars a year, averages one hundred and sixty-five 
per thousand. Where the income is seven hundred dollars, it 
drops to one hundred and twenty per thousand. With nine 
hundred dollars' income, we find the death-rate drops to 
eighty-five per thousand. At one thousand dollars a year, and 
over, it drops down to sixty-five per thousand. 

In Pittsburgh, the heart of the Steel Trust and the cancer 
spot of the steel belt, where the steel companies profess to 
have restored pre-war conditions, the hours worked are, never- 
theless, pretty much the same. More men are working twelve- 
hour shifts now than before the war. The annual earnings of 
over one-third of all productive iron and steel workers are, 
and have been for years, below the level set by government 
experts as the minimum of subsistence for families of five, 
while the annual earnings of seventy-two per cent of all 
workers were, and still are, below the level set by government 
experts as the minimum of comfort for families of five. 

Pittsburgh lost more babies in 1920, in proportion to its 
births, than any other of the large American cities for which 
reliable records are available. Its wastage of young life, for 
the year, exceeded that of seventeen cities of more than two 
hundred and fifty thousand population, in the birth registration 
area. The measurement of this loss by infant mortality 
rate: the number of deaths of infants under one year of age, 
per thousand born alive, shows that, for every one thousand 
babies born in Pittsburgh in 1920, one hundred and ten failed 
to survive throughout the year. This means a loss, during 
infancy, of one life out of every nine. 

For the same year, Boston had one infant death to ten births; 
Philadelphia, one to eleven; New York City, one to twelve and 
Seattle, one to eighteen. Compare Seattle to Pittsburgh and we 
find a rate twice as favorable as that for Pittsburgh. 

For the past four years, we find the difference still more 
surprising. Pittsburgh's average for four years was one hun- 



110 THIRD SESSION 

dred and twenty-two baby deaths under one year, for every 
thousand births; Boston, one hundred and three; Philadelphia, 
one hundred and three; Cincinnati, ninety; New York City, 
eighty-seven; Portland, Oregon, sixty-eight, and Seattle, fifty- 
eight. These figures do not tell the whole story, they merely 
give averages for an entire city. 

In Pittsburgh, where the workers live, we find infant mor- 
tality is more than a hundred per cent, higher than what 
it is where the well-to-do people live. The twenty-second 
ward of Pittsburgh is a working-class ward. Here the death- 
rate for infants under one year of age, during 1920, was one 
hundred and fifty-seven per thousand live births while, in the 
fourteenth ward, Schenley Park District, where the upper class 
lives, the death-rate, per thousand births, was sixty-four. In 
the first ward, another working-class ward, the death-rate for 
infants under or_e year of age is one hundred and fifty-six 
per thousand live births, while, in the thirteenth ward, a fine 
residential section, the rate is seventy per thousand. 

It is obvious, therefore, that infant mortality is, in a great 
measure, an economic problem and must be treated as such. 

Babies are precious and a joy to the home and are only 
a source of strength to the Nation when they are, themselves, 
healthy and when they do not drain and destroy the mother 
who bears them. But children, born under the circumstances 
I have just described, are not a joy to the family, or themselves, 
and are a liability to the Nation. Of those who live, how 
few grow to be healthy men and women. The fact that about 
one out of every four dies from tuberculosis is, in itself, a 
command for awakening of the social conscience. We must 
learn to recognize the difference between cause and effect. 
Today, society is trying to cure effect with charity, insane 
asylums, poor-houses, jails, clubs and bullets. Why not look 
for the cause and remedy the evil at its base? Then there will 
be no effect with which to deal. Let us raise the curtain of 
false modesty, teach the children sex-hygiene and the mysteries 
of their own bodies. Let rich and poor alike have free access 
to the knowledge of Birth Control. Hospitals, clinics and dis- 



BIRTH CONTROL 111 

pensaries must be left free to administer to suffering humanity. 
To do so means, not race-suicide, but race-preservation. 

The Chairman: I am going to ask Mrs. Sanger to introduce 
our next speaker, our distinguished visitor from England. 

Mrs. Sanger: When we were planning for this conference, 
we recognized that it was vastly important to bring to this con- 
ference some one v/ho would guide our activities for the future. 
The work that we have been able to do so far in the United 
States has been to propagate the idea of Birth Control in its 
relation to health, to individual economics, to woman's free- 
dom, also the historical and the legal aspects of the Birth Con- 
trol movement. But today, with the great international crisis 
upon us, it seemed to us necessary to have some one who could 
tell us how we should conduct our work in relation to the 
international problem of the work, so I went out to seek the 
man whom I considered the greatest authority on popula- 
tion, and that is Mr. Harold Cox, whom I take pleasure, and 
have the honor to introduce. 

WAR AND POPULATION 

By Harold Cox 

Editor of the Edinburgh Review; former M. P. for Preston; for two 
years Professor of Mathematics at Alyarh College, India. 

I FEEL MUCH honored at being invited to come across the 
Atlantic to address the First American Birth Control Con- 
ference. You have initiated here a great movement which, 
starting from small beginnings, is going to be perhaps one of. 
the biggest movements in the world. It is a pleasure as well 
as an honor for me to be present. I was greatly impressed 
last night by seeing the way in which this hall was filled with 
medical men and women, eagerly discussing practical methods 
of Birth Control. The fact that your League has been able to 
organize such a densely packed meeting of medical people is 
itself a proof of the progress you have already made. That 
progress, as you know even better than I know, has been largely 
due to one woman, a woman whom I feel proud to be allowed 
to call my friend. 



112 THIRD SESSION 

You have in America at the present time two conferences in 
progress: one in New York, the other in Washington. The 
one in Washington is engaged in considering how the nations 
of the world can get rid of armaments. But what are arma- 
ments? They are devices that men adopt to meet what they 
regard as the necessity of war. Armaments are merely a symp- 
tom of man's fear of war, or of man's desire of war, whichever 
it be. 

On the other hand, this Conference in New York is con- 
sidering how the causes of war can be removed. I will not go 
so far as to say that over-population is the only cause of war. 
In the past there have been many causes. In the past we have 
had dynastic causes, monarchs going to war for a matter of 
personal pride, or fighting for a tiny scrap of land because 
some racial or dynastic question was involved. A war of this 
character is incidentally recorded in Shakespeare's play of 
Hamlet, and I venture to quote to you Hamlet's comments: 

"I see 
The imminent death of twenty thousand men 
That for a fantasy and trick of fame 
Go to their graves like beds; fight for a plot 
Whereon the numbers cannot try the cause, 
Which is not tomb enough and continent 
To hide the slain." 

Such wars have to a large extent disappeared. Kings 
no longer hurl their subjects into war. Wars today are 
people's wars. Some peoples, it is true, fight about religion. 
But they happily are now in a minority. The one dominating 
object for which people still fight when the need arises is the 
room to live. People will always fight for the means of living. 
A man will sooner kill his neighbor than starve himself. Where 
the means of subsistence are insufficient for a people demand- 
ing to be fed war ensues. People fight to give effect to the 
demand so crisply expressed in the French saying: "Ote toi 
de la que je m'y mets" — "Get out of there that I may step in." 

This cause of war was emphasized by German writers in 



BIRTH CONTROL 113 

very candid terms before the Great War. A collection of 
various German opinions was published in Washington in 
1918 by the Committee of Public Information. It was entitled 
"Conquest and Kultur." I will quote a few passages. 

Arthur Dix, writing in 1901, says: "Because the German 
people now increase at the rate of eight hundred thousand 
inhabitants a year they need both room and nourishment for 
the surplus." 

Albrecht Wirth, writing also in 1901, says: "In order to 
live and lead a healthy and joyous life we need a vast extent 
of fresh arable land. This is what imperialism must give us." 

Daniel Frymann in 1911, in a work which had an immense 
circulation, called "Wenn ich der Kaiser ware," says: "It is 
no longer proper to say that Germany is satisfied. Our his- 
torical development and our economic needs show that we are 
once more hungry for territory." 

Von Bernhardi, in a book entitled "Germany and the Next 
War," published in 1911, says: "Strong, healthy and flourish- 
ing nations increase in numbers. They require a continual 
expansion of their frontiers. They require new territory for 
the accommodation of their surplus people. Since almost 
every part of the globe is inhabited, new territory must as a 
rule be obtained at the cost of its possessors; that is to say by 
conquest, which thus becomes a law of necessity." 

Germans were here expressing facts with brutal frankness. 
But exactly the same proposition was laid down 400 
years ago by an Englishman, whom nobody would call 
brutal. Sir Thomas More in his "Utopia" said that the people 
in his ideal country should keep their numbers down in accord- 
ance with the sustenance available. But if they increased be- 
yond the available sustenance they should go to the neighbor- 
ing country, and if possible by making friends with the people 
of that country peaceably settle there. And if they were not 
peaceably welcomed, then they must fight those neighboring 
people and take their land. 

The same cause of war still operates everywhere. As Lord 



114 THIRD SESSION 

Northcliffe, speaking in Australia recently, said: "Land hun- 
ger is the primary cause of war.'* 

Take the question of the Pacific. Japan has a rapidly grow- 
ing population. As a necessary result Japan is seeking an 
outlet for her people and for her manufactures. But the 
United States has a growing urban population living on urban 
industries, and urban industries must have foreign markets for 
their manufactured goods. Therefore the United States wants 
the Chinese market. Therefore the United States is opposed to 
Japanese expansion into China. Thus the expanding American 
population comes into conflict across the Pacific with the 
expanding Japanese population. 

It is conceivable that the Conference at Washington may 
reach some formula — politicians and diplomats are very good 
at devising formulas — which will hide the ugly facts, but the 
ugly facts will remain and sooner or later burst forth once 
more. 

Moreover, and this is a point I wish to impress upon your 
attention, the problem of population is becoming progressively 
more serious. That is a fact that is constantly ignored by the 
average man and woman. The tendency of almost everyone 
who discusses the problem of Birth Control, or the world prob- 
lem of population, is to limit their attention to the birth rate, 
forgetting that a low rate on a large number may give a higher 
return than a high rate on a small number. 

Most people would prefer to have one per cent, on 
a capital of a million than ten per cent, on a capital of a 
thousand. As the volume of population grows, even a reduced 
birth rate may give a much larger volume of increase. 

Let me give you a practical illustration. Before the war a 
great many people in England, observing the birth rate was 
declining, began to cry out, saying "We are losing our popu- 
lation. Race extinction is foreshadowed." What were the 
real facts? Between the years 1901 and 1911, while the birth 
rate was declining, our population increased more than in any 
previous decade in the whole history of England. It increased 
more in those ten years than in the whole of the eighteenth 



BIRTH CONTROL 115 

century. Why? Because though we had a low birth rate we 
had a large population, and on a large population a low rate 
gives a large increase. 

Between 1851 to 1911 we doubled our population. If that 
rate of growth had continued, in the course of 360 years Eng- 
land would have had a population considerably larger than 
the whole present population of the globe. Three hundred and 
sixty years is not a very big figure in the history of the world, 
nor in the history of many nations. In England it only bridges 
the gap between King Edward VI and King Edward VII. 

Let me now come to your own country. You are increasing 
more rapidly than we are. You may say you have more room. 
For the present, yes. But between 1880 and 1920 you con- 
siderably more than doubled your population. The actual 
increase was something over 110 per cent. If you continue 
that rate of increase, in two hundred years the population of the 
United States will be 4,313,000,000. I repeat: If the present 
rate of increase of the American population continues you will 
in less than two hundred years have over four thousand million 
people in the United States, or more than double the whole 
present population of the world. 

Similiar calculations apply to Japan or to Germany or to 
any other country. If any country were to maintain 
its present rate of increase it alone could fill the whole globe 
in a very brief period. This fact was pointed out by an Amer- 
ican, one of the most distinguished of all Americans that ever 
lived — Benjamin Franklin — over 150 years ago. He said the 
globe could be filled with a single plant like fennel, or with a 
single race, for example. Englishmen. 

There is a school of critics that says that any control of 
births is necessarily immoral. Many of these critics are them- 
selves as it happens celibates. They try to back up their con- 
tention by saying that there is still room on the earth. There 
may be for a time, but only for a time. These opponents of 
Birth Control further back their doctrine with a phrase often 
quoted — "God never sends mouths but he sends food." How 
about Chinese famines? There are millions of mouths in 



116 THIRD SESSION 

China craving for food. Every twenty years or so, often more 
frequently, you have a hideous famine in China. Parents 
then can do nothing with their children but drown them or let 
them die. You would have equally hideous famines in India 
but for the British Government which makes provision in 
advance. It is an absurdity to say that God sends food for 
the mouths of all the children that people choose to bring into 
the world. 

The figures I have given to you show clearly that a period 
must come when even the most dogmatic of theologians, even 
the most obtuse of thinkers, will see that there is no more room 
on the earth. What then will be said by these people who now 
denounce Birth Control? When they see the world obviously 
over-filled, will they still tell the masses to go on producing 
children to die within a few months, or alternatively will they 
tell them to produce children to kill other people's children? 
In efi'ect that is what is being done to-day. You have quite a 
considerable number of people in France telling Frjbnch 
mothers to breed more children to kill the children of German 
mothers; and you have some people in America who are plead- 
ing that American mothers must breed more children to kill 
the children of Japanese mothers. Is that the culmination of 
Christian morality — to breed children to kill the children of 
other nations? 

I contend that the most urgent duty of thoughtful people 
is to strive to change the public conscience of all nations 
with regard to the problem of population. At present govern- 
ments and churches are on the side of ever-increasing popula- 
tions. Governments subsidize the large families of the poor, and 
on this point I should like to express my disagreement with a 
previous speaker when he asked why the government should 
not do more to help these large families. It would be most 
mischievous. The responsibility of bringing a child into the 
world rests upon its father and mother and they alone are 
responsible for its maintenance. 

The churches also preach the duty of unlimited procreation. 
Why I do not know. Happily of late years there are signs of 



BIRTH CONTROL 117 

a change, especially in England. Among those who have come 
forward strongly in favor of Birth Control is the Dean of 
St. Paul's, Dean Inge. Another prominent English Churchman 
who has declared himself in favor of Birth Control is the 
Bishop of Birmingham. Quite recently a very significant 
episode occurred in England. On October 11th last Lord 
Dawson, who is one of the most highly distinguished members 
of the medical profession in England, and is the King's phy- 
sician, read a paper at the Church Congress on the subject of 
Birth Control. The keynote of his paper was, in his own 
words, "Birth Control is here to stay." He went on in the 
very plainest language to attack the theological view — which 
I may say has no basis whatever in biblical authority — that 
sex love is only permissible for the sake of producing off- 
spring. He said that this was an utterly untenable and ut- 
terly inhuman view, and he used a beautiful sentence which I 
will quote to you. "Life without the love of man and woman 
would be like the world without sunshine." Then he ended 
by telling the assembled clergy of the Church of England that 
it was their duty to approach this question in the light of 
modern knowledge and the needs of a new world. 

The upper and middle classes throughout Europe and 
throughout the United States are practising Birth Control. 
They are limiting their families. They have the knowledge; 
they see the necessity. The well-to-do artisans are doing the 
same thing. The rural laborers also, who are on the whole 
more intelligent than the poorer classes in the towns because 
they are brought daily in contact with the facts of nature, are 
also limiting their families. In our English villages families 
have become relatively small. It is in the slums that Birth 
Control is not practised. In those crowded areas of our large 
towns, where sunshine and fresh air hardly ever penetrate, 
the worst types are being daily brought into the world. It is 
these types that are multiplying; it is these types that are 
forcing modern nations to seek new outlets for their manu- 
factures. It is these types that force fresh wars upon the world. 
Happily in some countries public opinion has already recog- 



118 THIRD SESSION 

nized that we can only stop the evil by popularizing the knowl- 
edge and the methods of Birth Control, so that the "masses" 
may do what the "classes" already have done. That is recog- 
nized in England, where there are no laws against propagating 
this knowledge and where there is a growing volume of opinion 
in favor of it. 

Unfortunately the United States still has — if you will allow 
me to say it — foolish laws to forbid dissemination of essential 
knowledge — laws based upon a false standard of prudery and 
upon ignorance of the real facts of population. The figures 
I gave you just now show clearly that today the United States 
is increasing its population at a rate which in a comparatively 
brief period must produce an impossible situation. You can- 
not have four thousand million people in the United States. 
The present rate of increase must be reduced. You can only 
reduce the rate of increase by reducing the birth rate or by 
increasing the death rate. Which is it to be? For the sake of 
false ideals of prudery are children to be brought into the 
world to die in infancy, or are they to be brought into the 
world to kill the children of other nations? 

At present, unfortunately, the official attitude in al- 
most every country is against Birth Control. Some countries 
have even gone back on their previous policy. France, 
for example, in terror of Germany, has since the war passed 
new laws making it a crime even to advocate Birth Control. 
Why has France done this? Because England and America re- 
fused (I think unwisely and unjustly) to agree to protect 
France against Germany. In view of the failure of the pro- 
posed Anglo-American Alliance, the French say: "We must 
be strong enough to defend ourselves against the Germans, and 
therefore we must increase our population." They even post 
up in the streets placards "Faites des enfants" (Produce chil- 
dren). The idea seems plausible, but is really absurd. The 
population of France is about forty millions. The population 
of Germany is about sixty millions — 50 per cent. more. You 
will see at once that, supposing the French had a high birth 
rate and the Germans had an equally high birth rate, the 



1 



BIRTH CONTROL 119 

Germans would produce 50 per cent, more children each year. 
And that would go on from year to year, the balance getting 
more and more in favor of Germany. In other words, if 
France wants to go into a cradle competition with Germany 
she is bound to be beaten. So that remedy will not serve. 
Moreover if the policy which the French have adopted to pro- 
tect themselves from a fresh war were to be followed by every 
other country, fresh wars would be inevitable because there 
would not be room for everybody. 

How then is this madness to be ended? I contend that it 
can only be ended by a change in the mental attitude of 
all nations. And I say: Let the strongest nations lead the 
way. Let them set the example. If necessary, let the 
nations who have the wisdom to adopt a low birth rate for the 
sake of the prosperity of their children, for the sake of peace 
of the world, band themselves together and agree to defend one 
another against those races that will not reduce their birth 
rate. I hold that a League of Low Birth Rate Nations vv^ould 
be much more useful to the world than a League of Nations. 

In conclusion, may I sum up my argument in a few words. 
I contend that the ideal of peace on earth and goodwill among 
men is unattainable as long as we are too thick on the ground. 
Progress is impossible without room to live and leisure to 
think. This is no new doctrine. It has been endorsed by all 
economists of weight ever since Malthus first insisted upon its 
essential truth; it has been demonstrated by every type of 
living thing. Everywhere the lower races, whether plant or 
insect or animal, are the most prolific; everywhere the un- 
checked multiplication of rival species leads to mutual de- 
struction. If we wish to attain universal peace, if we wish to 
secure the progress of mankind, we must persuade all the 
peoples of the earth to limit their numbers. 

DISCUSSION 

Miss Helen Todd: I would like to ask Mr. Cox this. The 
statistics of both England and America show that the average 
wage on which a man and wife can afford to have children is 



120 THIRD SESSION 

about $1,500. a year, that is the minimum, or $2,000. Now 
according to our economic condition now, most of the millions 
of people could not afford to have any children. They might 
afford one miserable child, to live in the gloom that he pic- 
tures. But would you have to seal up the womb of the woman 
and leave her childless, or else even with one child? And what 
I would like to ask is this. Should not this doctrine of Birth 
Control, which has been so marvelously shown to us, should 
not the teaching go hand in hand with that other economic 
teaching that resources and wealth should be taken out of the 
hands of the few and put into some cooperative organization, 
so that a woman could afford to have children, one, two, or 
three children? Must not our Birth Control movement give 
economic teaching that the present system, which almost pre- 
cludes the women of the working class having even one child, 
is wrong and should be absolutely changed. 

Mr. Cox: I think the system would readjust itself. At 
present the multiplication of the children leads to the reduction 
of the rate of wages. That is what happened in England at 
the beginning of the 19th century when steam industry was 
introduced. The manufacturers wanted cheap child labor, and 
some of them actually gave bonuses to parents to produce chil- 
dren so they might get cheap labor. Large families mean cheap 
labor, and one great argument for smaller families is that you 
get a higher standard of living. 

Miss Todd: Under the statistics that were taken, the rate at 
which working men and women could have any family, the fig- 
ures which I remember were approximately $1,500 a year, 
for a man and wife and two children. And these were govern- 
ment statistics. They went on to show that the average work- 
ingman made about $800 a year, counting the times of un- 
employment. According to the unemployment in England, 
and our statistics here, the people could have no children what- 
ever, because with our present economic system they could not 
even afford one child. So it would mean that woman would be 
simply an instrument of sex pleasure. She could not even have 
one child under our present system. 



BIRTH CONTROL 121 

Mr. Cox ; I think I would answer to that, that I haven't much 
faith in government statistics. I will tell you of my first ex- 
perience with government statistics. When I was in India I 
was quoting to some judge some government statistics. He 
said to me very gravely, "When you have been in India a little 
longer, and have grown a little older, you won't quote gov- 
ernment statistics. Our government, like all governments, has 
a passion for statistics. It tabulates them and raises them to the 
nth power, but you must not rely on them. Every one of those 
figures goes back to the village official and he puts down what- 
ever he pleases." 

Mrs. Sanger: I would say in answer to Miss Todd, and I 
appreciate her question, that she would like to have every 
woman have the expression of motherhood and be allowed to 
have it, and that today the economic conditions make it impos- 
sible for a great many women to have that expression. It 
seems to me that our problem of Birth Control, and where we 
have to differ in making our first step from all the other ideals 
that we would like to bring about is, that our first step in this 
work is to stop the propagation of the unfit and the diseased 
and those who are carrying on the race. What will evolve out 
of this movement when children have become scarcer, when 
motherhood has been more dignified, is another problem that 
we will reach later. I think that is a question not of the pres- 
ent but of the future, and it seems to me that Birth Control 
today is not confronted with that problem as much as it is with 
the many millions of mothers who already have too many 
children. 

Mr. Jones: The method of approach to this problem is not 
that of seeking more government by the passage of additional 
legislation. It is more important for us to have removed from 
the statute books the legislation that exists. We are suffering 
already from too much government. If the restrictions now 
existing were removed, so that intelligent information would be 
wisely spread, people could see the problem themselves, and 
they will work it out for themselves, rather than through organ- 



122 THIRD SESSION 

ization of more government, and it is that way that we will 
reach the ideal that we are so interested in. 

Dr. De Vilbiss: May I say just one word to Miss Todd's 
question. I think that our approach to Birth Control will make 
this economic situation a little more easy of solution when the 
time comes. If perhaps through the limitation of families we 
are able to remove from the father not only that economic grind 
which is ordinarily expressed "keeping his nose to the grind- 
stone," but, in addition to that, the psychic drag on the father, 
which was brought out by our psychiatrists last night, and if 
we remove from the mother the depletion of her physical con- 
dition and allow her more leisure and more time to devote to 
educating her children; I am in hopes that through that in- 
creased intelligence and leisure we will work out a satisfactory 
solution of our economic problem. 

Dr. Hussey: I would like to call attention to the fact that 
while nations are trying to grab more territory and take it 
away from others by force, vast territories in all countries are 
held out of use by speculators, and we ought to pay a little 
attention to that. 



SESSION IV. 
SATURDAY, NOVEMBER 12, 1921, 2:30 P. M. 

Mrs. Hooker: We thought it would be most appropriate for 
the President of the American Birth Control League to preside 
for this final session of the conference. 

Mrs. Sanger (presiding) : We have a few papers that are 
going to be read this afternoon — papers that have taken a great 
deal of study and a great deal of thought, and they are from 
authorities on this subject. First w^e will ask Dr. Johnson 
to read the paper by Dr. C. V. Drysdale, of London. 

Dr. Drysdale who is advocating the Malthusian theory, is 
himself a scientist, and his mother and father and he himself, 
have been working to bring out this idea of Malthus for a long 
time. They take quite a different attitude in England on this 
question, and a much more scholarly attitude than we do here, 
and it is mainly owing to the work of Mr. Drysdale. 

BIRTH CONTROL AND DISARMAMENT 
By C. V. Drysdale, 0. B. E., D. So, (London), F. R. S. E., 

President of the Malthusian League, London 

AMONG the larger questions which agitate the minds of 
all civilized people today, few transcend in importance 
that of the avoidance of war and the reduction of the burden 
of huge armaments. The hideous conflict from which the 
world has recently emerged bleeding, exhausted, and impov- 
erished, and which has had its awful sequel in the strikes and 
labor unrest consequent upon the dislocation of industry, has 
united all thinking people in a detestation of war, and in a 
determination to prevent its recurrence. 

Out of this praiseworthy zeal, the League of Nations and 
the proposals for limitation of armaments have been born. 
With both of these developments all earnest humanitarians 
must be heartily in sympathy, but we must not let our en- 

123 



124 FOURTH SESSION 

thusiasm blind us to practical realities, and prevent us from 
giving consideration to every difficulty which may stand in 
the way of success. 

One thing is of good omen. The late war has justified to the 
hilt the contention of Mr. Norman Angell that the idea that 
nations may profit by conquest in war is a "Great Illusion." 
There is not a nation in the world which has not suffered 
grievously by the war; and although certain individuals may 
have profited financially by it, the terrible unrest caused by the 
increase in the cost of living and growth of anarchy must 
seriously militate against their enjoyment of their gains. 

Why then, should we fear the possibility of further wars? 
Surely the object lesson now before us should be sufficient to 
convince the statesmen of the whole world of the folly, as well 
as the barbarity of rushing into suicidal conflict. Why should 
we not beat our swords into ploughshares and settle down into 
peaceful industry, secure in the belief that no nation will 
again commit the criminal folly of letting loose the dogs of 
war? 

But I doubt if anyone, except a few blind idealists, will be 
ready to take this view; and certainly present events do not 
encourage us so to do. Greece and Turkey, Spain and Morocco, 
and some of the newly-created countries have broken out into 
conflict, in spite of the object lesson and of the strenuous efforts 
,of other nations to prevent them. The embers of wrath are 
smouldering so fiercely in Europe, that the whole continent is 
in a state of constant watchfulness and military preparation. 
Few who are in touch with the situation would be bold enough 
to assert that there is no possibility of another great war 
breaking out within a few years, even between the nations who 
have suffered most heavily by the last one. The League of 
Nations has been formed and is working strenuously, but even 
its greatest well-wishers would hesitate to confide the fate of 
their own countries to its protective efforts. There seems in- 
deed to be some Great Fact which Mr. Norman Angell has 
overlooked in his "Great Illusion," and of which people are 
vaguely, if not definitely, conscious, that drives nations into 



BIRTH CONTROL 125 

war, in spite of all assertions and proofs that they cannot expect 
to gain by it. 

Now is there such a compelling agency, and if so, what is 
it? Yes, there is, and it is the pressure of population. It is 
surely unnecessary to labor this point in view of the utterances 
which came to light in the course of the late war. The greatest 
statesmen and military geniuses of the ages — to cite only 
Aristotle, Bacon, Napoleon, General Brialmont, and the ex- 
Kaiser — have recognized this fact, and the "biological neces- 
sity" for war was the slogan and justification of German 
militarism. The rapid growth of the German population and 
the consequent need for expansion were put forward by the 
militarist writers like General Bernhardi, as a justification for 
war, and it was accepted as an article of faith by the German 
people. It was a logical deduction from the Darwinian theory 
of the struggle for existence and the survival of the fittest, to 
which all educated people had paid lip service, without the 
courage to face its great consequence — Birth Control or war. 
The great crime of Germany was that after clearly recognizing 
this conclusion she deliberately chose the brutal course of 
glorifying and intensifying the struggle and its inevitable 
result; but the whole of the remainder of the world, or at least 
the conventional portion of it, must stand convicted of being 
accessory to the crime by also deliberately refusing to face the 
alternative, and by glorifying the "increase and multiply" 
policy which led to it. 

Although the general proposition that a high birth rate leads 
to militarism and war is generally admitted by thinkers at the 
present day, especially by those who have compared the birth 
rates of European nations, few have given any attention to the 
mechanism by which it operates. It will be well, therefore, 
to give a little consideration to this point, as it helps to clear 
our minds of many misconceptions. The fundamental doc- 
trine of Malthus, which stands as the unshakeable foundation 
of all rational sociology, teaches that unrestrained population 
always tends to press upon the means of subsistence, and that 
in all long settled communities it constantly does so. Today, 



126 FOURTH SESSION 

in every country in Europe (with the possible exception of Hol- 
land) and in the United States of America, the birth rate is 
still too high, in spite of its rapid decline in the last few 
decades, to permit of adequate provision for all the newcomers; 
and consequently the death-rates are higher than they should be 
if all the people were sufi&ciently well-fed. In the Eastern 
nations such as India and China, as well as Russia, with their 
enormous birth-rates, the death-rates are terribly high, betok- 
ening a constant state of semi-starvation in the great mass of 
the people; and although an immense improvement has taken 
place in Western nations with the fall of the birth-rate, there 
is still a greater or less proportion of the population in nearly 
every country in a state of chronic destitution.- It is to the 
credit of American economists that they have kept this great 
fundamental truth alive in their writings, while the economic 
writers of the land which gave birth to Adam Smith, Malthus, 
Mill, Darwin, and Spencer, have allowed conventional pre- 
judice and socialistic fallacies to dominate, or silence, their 
consciences. 

Now, the effect of this over-population on a community 
depends on its temperament. Where the mass of the people 
are apathetic, either by nature or by religious resignation, to 
misery, they die off without protest or struggle, and do not 
menace surrounding nations. But in proportion as the people 
are high-spirited and are rebelling against their evil conditions, 
they exert a pressure against other countries, which leads to 
international rivalry and sooner or later to war. Almost 
every nation may be likened to a boiler in which steam is 
being generated and the pressure is continually rising. As 
every student of physics knows, the pressure is due to agitation 
of the molecules of the steam which may be likened to the 
individuals forming the community and their impact against 
each other and the walls of the boiler, the fire which produces 
the fresh molecules of steam being comparable to the repro- 
ductive force of humanity which produces fresh individuals. 
If the boiler were of easily yielding material so as to be like a 
balloon, the production of steam could go on practically un- 



BIRTH CONTROL 127 

checked for a considerable time, and this would be equivalent 
to a new community in a large, practically unpeopled, country 
affording room for very rapid expansion, which was nearly the 
case with the United States in the early part of last century. 

But a time must come sooner or later when the available 
space is practically occupied and the pressure begins to rise. 
It can, however, be kept to a fairly low value if the boiler is 
leaky. The leaks for population which may prevent the pres- 
sure rising to the bursting point are all those agencies which 
cause premature death — starvation, pestilence, disease, infanti- 
cide, crime, drunkenness, and noxious drugs, etc. If people are 
willing tamely to submit to this leakage without effective pro- 
test, as in China and to a less degree in India, they will not 
exert a pressure on their frontiers and neighbors, and will not 
be aggressive. Emigration is another leak which may help to 
keep down the pressure. But in scientific progressive nations 
the leaks are being continually stopped up. Medical science 
and sanitation made the start by rapidly reducing the pes- 
tilence and disease leaks, and during the last few decades the 
masses of all civilized countries have awakened from their 
submission to the starvation check by making stronger and 
stronger demands upon the economic resources of their coun- 
tries. Emigration has also been checked, both by the increase 
of pressure in other countries, which has made it less advan- 
tageous, and by the embargo which one nation after another 
has recently been putting on the emigration of pauper aliens. 
In consequence, the pressure of population has tended to rise; 
and had it not been for the counteracting effect of Birth Control 
which has to some extent mitigated this tendency, it is safe to 
say that militarism would have been more rampant and wars 
more frequent than they have been. Justification for this view 
may be offered at this point by calling attentisn to the fact that 
the lowest birth-rate nations — France, Holland, Belgium, Scan- 
dinavia, the United Kingdom, Switzerland, etc., have been 
remarkably pacific in their recent tendencies as compared with 
the higher birth-rate nations — Germany, Russia, the Balkans, 
etc. 



128 FOURTH SESSION 

The process which leads to war can thus be clearly seen. 
Even in primitive society, where lawlessness, ignorance and 
superstition make for a high death-rate, the expansive force of 
reproduction is so great that famine is of periodical occurrence 
and intertribal warfare results. As civilization advances, 
diplomacy and international agreements step in, tending to pre- 
serve peace; but at the same time medical science, sanitation, 
and humanitarian legislation stop up the leaks and intensify 
the pressure, even in the face of a falling birth-rate. The 
internal resources of most long-settled countries being in- 
sufficient to provide food for their inhabitants, a commercial 
struggle ensues in which each country tries to produce goods 
to exchange for the food of other less crowded countries. For 
this purpose it is necessary to capture the most important mar- 
kets and to produce goods at the lowest possible cost in order 
to hold them against competitors. The capturing of markets 
leads to international jealousy and friction, and the process is 
intensified by the continual efforts of the wage-earners through 
strikes and agitation to get higher wages and thus increase the 
cost of production. Just as in the case of our steam boiler, 
any pressure in one part is diffused through the mass and tends 
to strain it to the bursting point. The rivalry and friction grow 
in spite of the efforts of the diplomatists to allay them, until 
the explosion comes and the world is plunged into war. 

The importance of this aspect of the question is that it puts 
a totally different face on the origin of war to that which is 
popularly imagined. The popular idea is that war is caused 
by the ambition of rulers, or the machinations of greedy cap- 
italists, and that the well-meaning masses who desire to live 
at peace with their neighbors are hounded into war for the 
vanity or avarice of these evil workers. However plausible 
this may appear on the surface, it is an absolutely false view 
of the situation. We are all responsible for war, and we must 
realize our responsibility if we wish to prevent its recurrence. 
I do not mean that we are all equally responsible in fact or 
intention; but no pacifist or socialist can stand aside and say 
that because he has a horror of war and has written in denun- 



BIRTH CONTROL 129 

elation of it he is absolved from responsibility for it. On the 
contrary, all those who have spent their time in preaching vain 
ideas instead of in increasing production, and all those who 
have attempted to wrest a greater share of the produce of the 
community through labor agitation or demand for humani- 
tarian legislation, have assisted in increasing the competitive 
struggle between nations in order to supply their needs or de- 
mands and have contributed largely to the forcing on of war. 
The medical profession in its constant conflict with death, and 
in its succor of unfit types, has been a most powerful war 
maker. It is true that when the pressure is high there are 
certain rulers and individuals who see a prospect of advantage 
to themselves in a war, and may cause a somewhat premature 
explosion; but the pressure and rivalry arise from the mass of 
people, and the machinations of emperors and capitalists would 
be of no avail if the pressure were not there. 

This is the meaning of the German "biological necessity for 
war" which is remorselessly true, unless the birth-rate of each 
country is restricted to the level which enables its inhabitants 
to live on its own resources or on the amount of foreign trade 
which arises from an actual desire on the part of other coun- 
tries to obtain their manufactures. Unless this is recognized as 
a fundamental principle by the League of Nations its efforts 
will be of very little value and no sane patriotic people will be 
willing to disarm and entrust the security of their country to 
its imaginary protection. 

But now that Birth Control is available and that the great 
majority of people are eager to avail themselves of it, the whole 
outlook is changed. If the knowledge of hygienic methods of 
Birth Control were made available to all adult people, as the 
most elementary principle of liberty demands that it should 
be, all young people could marry early and only have as many 
children as they could bring up comfortably by their own un- 
aided efforts, the competitive pressure of each family against 
its neighbors would be removed, and the pressure of the whole 
nation against its frontiers or neighbors would disappear with 
it. If this happy state of affairs comes to pass in a few years, 



130 FOURTH SESSION 

as it appears likely to do in some of the great European nations 
at least, the shadow of militarism will recede, the League of 
Nations will gain real power ,and progressive disarmament can 
be undertaken without fear. 

There are many who will admit the justice of this view, but 
maintain their opposition to Birth Control on the ground that 
it is unsafe for one nation to diminish its birth-rate in advance 
of other nations. This is the most serious difl&culty in the 
situation, and it needs vigorous handling by the advocates of 
Birth Control. 

What I specially want to make clear is that Birth Control, 
while diminishing the aggressiveness of a country, actually 
increases its defensive powers. Just as the same wind may cool 
a hot body and warm a cold one, so Birth Control will dimin- 
ish militarism and increase military strength, and there is no 
greater paradox in the one statement than in the other. Surely 
it is patent by this time that large populations enfeebled by 
want are not a source of military srengh. China, Russia, and 
India have the largest populations in the world, but no one 
seriously regards them as great military powers. Any danger 
which exists in the East does not arise from them, but from 
the Asiatic country which has the smallest population and the 
lowest birth-rate — ^Japan. 

But now comes the point when the true meaning of the pop- 
ulation question appears, and which shows why birth-con- 
trollers ought to give the greatest possible attention to the 
fundamental Malthusian doctrine. 

Birth Control, especially when eugenically applied, does not 
lessen the numbers and even causes them to increase more 
rapidly. 

This is the most important matter from the national stand- 
point which we can possibly deal with. It is perfectly simple, 
but it seems very difficult for most people to understand it. 

Imagine a family living alone on a small islet, and therefore 
composing a small state in itself, with just enough food to 
support the husband and wife and four children. If the parents 
have four children all will be well, and they can bring them 



BIRTH CONTROL 131 

up to vigorous maturity. But suppose they have 12 children. 
The eight additional mouths to be fed will mean a reduction of 
rations all around; and unless the parents deliberately make a 
selection of the four which are to survive and let the others 
perish quickly, the attempt to preserve all will lead to such 
a serious weakening of the whole family that the whole of the 
children may die, or at most only one or two survive. In other 
words, the arrival of each child beyond the maximum actually 
diminishes the amount of survival, besides seriously impairing 
the vigour of those who do survive. Consequently, if by Bir'ih 
Control the parents are able to restrict their family to the 
number they can feed properly, they will actually gain a 
greater and more efficient increase than if they have an un- 
limited family. 

A nation is simply a congeries of such families, and what is 
true for the family is true for the nation as a whole. When we 
observe the individual families of a nation, the rule does not 
appear to hold, as we find many instances of families of ten or 
a dozen children in which the bulk have survived. But this 
i" generally because such families have received assistance 
either from the State or from other individuals, which means 
that they have received supplementary rations from the com' 
mon stock. The result is that through taxation or high prices 
others are either prevented from marrying or (if they have 
Birth Control knowledge) limit their families to a greater 
extent than they would otherwise have done. Celibacy and 
very small families are common among the educated, prudent, 
and public-spirited classes, because of the increasing burden 
laid upon them by the large families of the poor and ignorant. 
Although, therefore, it may appear to the superficial observer 
tliat large families are the great source of increase of popula- 
tion, this is certainly untrue when the whole of the phenomena 
are taken into account. 

Today, owing to the ignorance of Birth Control methods, we 
have the degrading spectacle of a large section of poor women 
condemned to the torture of bringing forth an unlimited num- 
ber of weakly underfed children, partially supported by the 



132 FOURTH SESSION 

efforts of the educated classes, whose women are denied mar- 
riage or maternity in consequence. I have shown, and the 
experience of France confirms it, that if all women married 
and had an average of three children, the increase of pop- 
ulation of any European country would be as high as it is now, 
as this would mean a 50% increase in under 30 years, or a 
doubling of population in about 50 years. Any attempt to 
increase faster than this has the same results for the nation as 
for the isolated family — a high death rate and an actual reduc- 
tion of the rate of increase owing to the useless consumption of 
abbreviated lives, and a reduction of efficiency from under- 
nutrition. Birth Control for the nation, as for the family, 
actually enables the population to increase faster by eliminat- 
ing useless consumption of food. And, further, if it is selec- 
tively applied, so that the poorest, diseased and least efficient 
types reproduce less, as natural inclination would lead them 
to do, the efficiency of the race and its productive power would 
be increased, and a more rapid increase of population could 
be sustained. 

"Pure theory," it will be objected. But the fact confirms it. 
In the majority of European countries the birth-rate has been 
steadily declining during the past four decades at least, the 
starting point of the decline being in many cases the Brad- 
laugh and Besant trial of 1876, which was the means of spread- 
ing contraceptive information all over the world. But in every 
case the death-rate has fallen with the birth-rate, and in some 
instances at an even greater rate, so that the rate of natural 
increase of population is actually greater now than before the 
decline of the birth-rate set in, just as our theory indicated. 
Even in France, which has so often been held up as a terrible 
example of a "dying nation," and in which the birth-rate fell 
from 38.9 per 1000 before the Revolution to 20.6 per 1000 in 
the decade 1901-1910 (see Fig. 2), the death-rate fell from 
37 to 19.4 per 1000, so that she was still slowly increasing in 
numbers at the rate of 1.2 per 1000 per annum, and almost as 
fast as when her birth-rate was nearly double the pre-war 
figure. The low average increase of France is explainable not 



BIRTH CONTROL 133 

by her low birth-rate but by the fact that her food resources 
can only be increased very slowly, as her agriculture was 
developed to a very high degree even before the Revolution, 
and she has had very few mineral resources to enable her to 
be a successful manufacturing nation. As Ontario, in Canada, 
with a similar birth-rate, had a death-rate of only 10 per 
1000, or a 9 per 1000 increase, it is obvious that France could 
greatly increase its acceleration of population by decreasing its 
death-rate if its food supply permitted, and that appeals for 
an increase of its birth-rate are worse than futile. 

Germany has witnessed an extraordinary fall in its birth- 
rate since 1876 (see Fig. 3), but its rate of increase up to the 
beginning of the war remained practically as high as ever. 
In fact the rate of increase of Western Europe (Fig. 4) has 
shown a steady acceleration since the decline of the birth rate 
set in, in 1876. 

Holland, however, shows the most remarkable verification of 
this theory. As is now fairly generally known, the Neo-Mal- 
thusian movement in Holland, which started in 1881, was able 
to work almost from its inception with greater freedom 
than in any other country, and to give Birth Control infor- 
mation freely to the poor. Thus Holland is the only country 
in which Birth Control has had an opportunity of being ex- 
ercised on eugenic lines. The result has been exactly what 
Neo-Malthusians predicted (see Fig. 5). The birth-rate has 
fallen from 37 per 1000 in 1876 to 28 in 1912, but the death- 
rate has fallen from about 23 per 1000 to 12.3 So the rate of 
natural increase has actually risen from 14 to 15.7 during the 
period, and before the war it was about the highest in Europe. 
The infantile mortality has also fallen rapidly and regularly; 
and the general death-rate in Amsterdam and the Hague, the 
two great centres of the propaganda, was only 11.2 and 10.9 
respectively in 1912, the lowest for any large towns in Europe, 
and nearly as low as the record death-rate (about 9.5) for 
New Zealand. 

And the effect on the national physique, as evidenced by the 
Army returns, is no less marked. Since 1865 the proportion 



134 FOURTH SESSION 

of young men of over 5' T' in height has risen from 24.5 to 
47.5% while that of those under 5' 21/2'' has fallen from 25 
to under 8%. Indeed, Dr. Soren Hansen at the first Eugenics 
Congress actually asserted that the average stature of the 
Dutch people had increased by 4 inches within 50 years. 

Whether this is due to Birth Control, as we Neo-Malthusians 
contend, or not, these facts prove beyond the possibility of dis- 
pute that a considerable reduction of the birth-rate may take 
place with an actual acceleration of numbers and an immense 
improvement in military efficiency, which is exactly what we 
have contended. But in spite of this rapid increase of strength, 
Holland has certainly not shown the least sign of military am- 
bition or aggressiveness. She is able now to live on her 
agriculture and industry without undue stress, and she asks 
nothing more than to live at peace with the world. We never 
even hear of her in connection with the international com- 
plications and disputes, although the intense patriotism of the 
Dutch people needs no proof. 

It cannot therefore be gainsaid that the only country in 
which Neo-Malthusian propaganda has been given fairly free 
play, and in which the mass of the people are able to regulate 
their families in accordance with their own desires, has com- 
pletely vindicated our contention that a universal knowledge of 
Birth Control strengthens a country for defence while removing 
all cause for offence. If the example of Holland were followed 
by the whole civilized world, each country would become so 
strong and at the same time so pacific that the risk of war 
would rapidly disappear and the League of Nations would be 
able steadily to gain such support and strength that its pro- 
tective power could be relied upon, and disarmament could be 
undertaken by all Powers simultaneously without danger. 
Until this happy state of affairs exists, however, the only 
rational step is to aim for a federation of all the low birth-rate 
nations. Scandinavia, Holland, Belgium, Great Britain, France, 
Switzerland, United States, Australasia, Canada, and now even 
perhaps Germany and Austria, have already lowered their 
birth-rates well below the 30 per 1000 mark, and should be 



BIRTH CONTROL 135 

ready to bind themselves into a Federation which will not only 
keep the peace in Europe, but form an impregnable protection 
against any possible attack from the East. But if the opponents 
of Birth Control keep up their senseless and suicidal repression, 
and keep the poor in misery and ignorance, nothing can pre- 
vent constant labor unrest with its injurious effect upon indus- 
try, over-population, and international rivalry for markets, 
with the friction it engenders and the need for huge armaments 
to back up this rivalry; while on the other hand the class 
hatred and suspicion born of evil economic conditions will 
inevitably tend to ever greater national insecurity. The op- 
ponents of Birth Control are the greatest enemies of peace and 
prosperity, and it matters not how loudly they proclaim the 
ideal of international brotherhood so long as they maintain 
this opposition. 

Another most serious factor in the situation nowadays is 
that if the mass of the people are discontented and at war with 
society they may form a most formidable menace to the power 
of their country in time of war by strikes and the holding up 
of the production of munitions, etc. Nearly every nation was 
seriously weakened by this difficulty in the late war, and there 
can be no doubt that this difficulty will be more grave in the 
future unless economic conditions are improved by Birth 
Control. 

The Neo-Malthusian formula for attaining lasting peace and 
removing the need for armaments is therefore as follows: 

(1) Birth Control information should be made freely access- 
ible to all adult married persons so that people may marry 
early and regulate their families in accordance with their 
health and economic position, without seeking help from others. 

(2) The fall of the birth-rate should be encouraged so long 
as it produces a nearly corresponding decrease of the death- 
rate, and each country should strive to secure that its death- 
rate does not exceed the 9 or 10 per 1000 of New Zealand. 

(3) While encouraging Birth Control in their own countries, 
all true patriots should join in assisting missionary Birth 



136 FOURTH SESSION 

Control propaganda in all high birth-rate countries, and espe- 
cially in Russia and the East. 

(4) While not putting at present too great faith in inter- 
national efforts, such as the League of Nations, every nation 
ought to assist them by all means in its power in order that 
they may become effective as the birth-rate falls in all coun- 
tries. But they should also insist that the League of Nations 
should recognize the population difficulty and regulate its 
policy and decisions in relation to it. 

(5) While waiting for and assisting the reduction of the 
birth-rate in all backward nations, a Federation of Low Birth- 
Rate Nations should be formed for mutual support and pro- 
tection, to which other nations should be admitted as their 
birth-rates fall, say to below 30 per 1000. These nations can 
agree among themselves upon a certain limitation of arma- 
ment consistent with presenting an impregnable united defence 
to outside aggression. 

(8) The Federation, as the nationis successively reduce 
their birth-rates to the point of being admitted to it, will grow 
in power until the point is reached when it can dictate limita- 
tion of armaments to all other nations and constitute itself into 
an international authority holding sufficient power to enforce 
its decisions without needing more than a mederate force to 
back it. From that time onwards all international questions 
will be regulated by the international law laid down by the 
Federation and war will be definitely eliminated. 

There is nothing Utopian about this programme. It is 
based on a full recognition of the causes and past necessity for 
war and not on any vain appeal to high sentiment. It does not 
call for any immediate sacrifice on the part of any nation for 
a risky experiment, but gives a procedure whereby the path of 
pacifism may be steadily followed, however gradually, until 
the goal is reached. 

It is hoped that the above statement will prove clear and 
convincing, and that it will lead to the adoption of the follow- 
ing resolution, which has been drawn up in conformity with 
these views: 



BIRTH CONTROL 137 

"This meeting desires to call the attention of all those who 
are desirous of maintaining interntional peace and securing the 
limitation of armaments to the supreme importance of the 
population question. We maintain that the pressure of popula- 
tion caused by too high birth-rates inevitable causes an eco- 
nomic rivalry between nations which forces them into war, 
even against their inclination, and in spite of all efforts of 
pacifists, or realization of the horrors and economic evils of 
war. While, therefore, we cordially endorse the aims of the 
League of Nations and the desirability of limitation of arma- 
ments we would impress upon all supporters of these ideals that 
they should seek to realize them by the following means: 

(a) By assisting the Birth Control movement to disseminate 
the knowledge of hygienic methods of Birth Control especially 
among the poor and unfit of all nations, with the object of 
reducing economic stress and eliminating poverty and unfitness, 
which forces nations into war, but weakens them in times of 
crisis. The reduction of the Birth Rate in all nations should 
be encouraged in its own interests, so long as the death-rate 
falls pari passu with it, and it may be provisionlly assumed 
from the examples of New Zealand, Australia and Holland 
that a death rate of about 10 per 1000 should be aimed at as 
marking the termination of economic stress. 

(b) By urging on the League of Nations that it should en- 
dorse the above policy, and that it should define its attitude 
to the population question, either by admitting the right of 
rapidly increasing nations to expansion of territory at the 
expense of slowly increasing ones, or by laying down the prin- 
ciple that each nation must control its population so as to be 
able to maintain its inhabitants in comfort within the area as- 
signed to it, and that it shall have no right to demand increase 
of territory or to force other nations to receive its emigrants 
if it does not exercise this control. 

(c) By advocating the formation of a Federation of Low 
Birth-Rate Nations including all those with birth-rates of 30 
per 1000 or less, and commencing with the United States, the 
United Kingdom, Scandinavia, Holland, Belgium, France, 



138 FOURTH SESSION 

Switzerland, Australasia and Canada, bound together for mu- 
tual defence against aggression." 

The Chairman: I think we all recognize that the forces of 
opposition are breaking down gradually, and it may be perti- 
nent to say that a good deal of the success of this movement is 
going to depend upon you. It is going to depend upon how 
much support you will give us who are directing and guiding 
this movement. It is open for your suggestions and it is open 
for your help. 

We intend to direct our movement so that the force of oppo- 
sition will be lessened. I think that the first thing is that we 
intend to oflfset the opposition by our methods of disseminating 
this information of Birth Control. We are going to put it into 
the hands of scientists and into the hands of the medical pro- 
fession. This will safeguard the information from being prom- 
iscuously circulated. Our aim is not only to open the doors so 
that physicians may give information in their regular practice, 
but also that clinics may be established for the particular pur- 
pose of giving such information when women come and request 
it. I think that this offsets the argument of the opposition that 
boys and girls are going to have this information, and it is 
going to be promiscuously passed throughout the country. 
Under present condition there may be places where printed 
literature is important. But, nevertheless, the immediate thing 
is to have individual instruction given to women who need it 
by people who are informed and who are capable of directing 
and informing the individual woman concerning her particular 
problem. 

We found last night from the crowded room of physicians, 
that the whole medical profession was not in agreement as to 
any one method, and that is what we have always contended, 
that there is no one magic means of Birth Control, that each 
woman must be met individually with her particular physiology, 
and her particular economic problem, and the physician or the 
person in charge must direct the best possible means for her 
particular position. That is the first step by which to avoid 
or break down the opposition. 




BIRTH CONTROL 139 

SOME THOUGHTS ON THE MEDICAL ASPECTS 

OF BIRTH CONTROL 

By Dr. W. F. Robie, Baldwinville, Mass. 

(Dr. Robies paper has been published elsewhere and is omitted 
at his request.) 

BIRTH CONTROL AND PSYCHOANALYSIS 

By Dr. Andre Tridon, New York 

I WOULD like to examine this afternoon the problem of 
Birth Control, not from a theoretical but from a perfectly 
practical point of view. 

I am not interested at all in knowing whether Birth Control 
is moral or immoral. That does not interest me at all for one 
very good reason. Every one on earth excepting the very 
stupid and very ignorant is practising Birth Control. It is 
not a question of trying to influence the masses and make them 
consider the thing as moral or immoral. We have to deal with 
one tremendous fact. The masses are practising it, with the 
exception, as I said before, of the stupid and the ignorant and 
the so-called lower races. But as you know very well, every 
new step toward comfort means a new step toward more com- 
plete Birth Control. 

And I cannot say that I am very interested in knowing 
whether Birth Control is legal or illegal. Legislation as a rule 
is about a hundred years late in expressing public opinion. 
And if we wait for legislation to make it legal, we will have 
to enlighten first those packs of yokel editors, small village 
lawyers, and former bar tenders who make up the parliaments 
of almost every nation. But it will lake too long and in the 
meantime women will be dying. We cannot wait for those en- 
lightened parliaments of the world to make something legal. 
There are many legal reasons for which an abortion can be 
performed. You might just as well call things by their names, 
since we are met for the purpose of discussion. A woman who 
is suff^ering from tuberculosis, a woman who has kidney or 
heart trouble, or sufi"ering from a hemorrrhage, can call upon i. 
physician to have an abortion performed legally. The day 



140 FOURTH SESSION 

when our physicians and our less stupid representatives in 
parliament realize the meaning of fear, they will probably add 
fear of pregnancy to the new causes for which an abortion can 
be legally performed. 

When I speak of fear of pregnancy I mean that fear as 
accepted especially among the class of women who would be 
likely to consult me professionally, among neurotics, who other- 
wise are called nervous or hysterical women. 

I have seen cases which are extremely tragic. I do not 
agree with Freud that every mental disturbance should be 
traced to some slight sexual abnormality. There are thousands 
of other things which may vex a mind. At the same time we 
cannot deny, no one can deny the tremendous and terrifying 
influence of the sex phenomena in our modern life. We so lie, 
we are so hypocritical about it, we pretend so much, that we 
have created a terrifying mystery of sex and of the various 
consequences of the sex life. And whenever there is a dis- 
turbance of the mental process known as neurosis or insanity, 
we find that wherever there is a sexual difficulty it is amplified 
beyond measure by the neurotic. In about a dozen cases which 
have come to my observation I have seen that fear of conse- 
quences and fear of abortion were really at the bottom of at 
least fifty per cent of the trouble as it was exhibited in my office. 

In a neurotic there is a decided refusal — and this is after 
all the most modern definition of the neurosis especially of a 
neurotic woman — there is an absolute refusal to fulfill one's 
biological duties. By duties I mean, of course, duties in the 
scientific and biological sense. There is a refusal based very 
often on some fear which is based in its turn on a certain 
feeling of inferiority. Study a neurotic woman and she will 
some time or other express a fear, which is not a fake, which 
is genuine, that should she give birth to children they will prob- 
ably be insane or neurotic or inferior, as she imagines that she 
is. Now, then, with our present legislation when we force a 
nervous woman to have children, what are the results? Either 
she bears them or she does not. If she does, she bears children 
who are not wanted, who are not welcome. I do not believe in 



BIRTH CONTROL 141 

more than ten per cent there is the so-called influence of 
heredity. I don't believe at all in prenatal influence, because 
you know that the child in the mother's body is completely 
isolated from the mother's body and has no nervous connection 
with the mother's body at all. But I believe that as soon as the 
child is born it begins at once to feel automatically through its 
nervous system that it is not wanted, that it is an intruder. I 
believe that if a neurotic did not want the child, the child will 
every moment of its life feel that it is inferior, that it is not 
like other children. And finally, by allowing the neurotic to 
have children, it will cause another generation of neurotics, 
not I believe because that neurosis is transmitted by any way 
of heredity, but because I know that imitation is one of the 
most tremendous factors in real life, and that the child of a 
neurotic will probably imitate his father or mother, whichever 
one is neurotic. Hence, as far as the results of our present 
legislation are concerned, I see two tragedies for two gen- 
erations. The neurotic woman will be compelled to bear 
children which she does not want to bear. One generation will 
be tortured by that; and the next generation, probably as 
neurotic as the first, will also be a victim of the law. In other 
words, I see two victims of two generations of that marvelous 
law of ours. Or, in spite of the law, the neurotic woman who 
becomes pregnant will have an abortion performed. 

First of all, before she becomes pregnant, all her sex life 
will be simply tortured by the fear of possible pregnancy. 
Investigate all those cases of psychic incidents of the rigidity 
of women. Investigate all those cases of curious pains, curious 
so-called female trouble; investigate many of those unlocated 
pains which have caused the removal of so many normal, 
healthy ovaries; investigate so many medical cases which my 
medical confreres probably have discussed with you, and al- 
ways at the bottom of those troubles, if you investigate far 
enough, if your cross examination is ruthless enough, you will 
always find the fear of the consequences, terribly magnified, 
and the fear that if some means of contraception go wrong, 
there will be a pregnancy; and even with the possibility of 



142 FOURTH SESSION 

finding a physician willing to perform an abortion, there is the 
fear of something going wrong and poisoning setting in. And 
those of you familiar with the operation necessary to abort a 
foetus know that what kills the woman from that operation is 
not septic poisoning, but septic poisoning induced by fear of 
that operation. The fear of operation has killed more people 
than the operation itself. Those of you familiar with the 
chemical changes which take place in the blood know that fear 
may cause almost anything, from poisoning to melancholy, to 
death itself. 

Our legislation prevents abortion just about as much as the 
Volstead law prevents getting drunk. The problem for the 
average man in New York City is not to find alcohol, but to 
dodge bootleggers. That has been my experience. The only 
difference in our situation since the Volstead law is that instead 
of getting excellent beer cheap, or good wines, we can only 
buy wood alcohol, slightly modified, colored or perfumed. 

The same thing happens in the field of preventing abortions. 
We have quacks, only quacks at present, who dare openly be 
known as performing abortions, although I suppose that 
99 physicians out of a hundred will do it if you will pay the 
price and if you know them very well. That law transforms 
us into liars, transforms us into hypocrites, and the results 
are deplorable. 

I would like to give you very briefly one or two cases, al- 
though I think a brief outline of those cases won't sound very 
real to you. There was a woman who had four children, and 
after the fourth one decided not to have a fifth one. And after 
consulting with a few friends of hers she was referred to a 
midwife. She had no confidence at all in that woman — there 
was no one else who was willing to perform the operation. 
Going to that operating table in that splendid frame of mind, 
we can imagine what the results were. . There was septic 
poisoning and for about three months she was between life and 
death, wondering whether she would die or live, when a phy- 
sician performed a curettage and she survived. After that, 
conscience, which, roughly speaking, means the fear of ex- 



BIRTH CONTROL 143 

posure and the law, began to hurt her. I am not speaking theo- 
retically, I want to be practical and just pass information 
exactly as it was, regardless of what it sounds like. I never 
care what my things sound like. Truth never sounds very 
nice. Truth, as you know, could not appear on Fifth Avenue 
because she goes about naked. The police would take liberties 
with her on that account. They always do. So that woman 
then recovered, and after that, as she was naturally neurotically 
inclined, and should never have had children, began to 
build up a beautiful fancy that she was one of the greatest 
murderesses on earth. She felt extremely sinful. She began 
to develop a neurotic fancy that she had destroyed a human 
life, hence a sinner and murderess, and began logically to de- 
cide that as long as she was a sinner, a murderess, a degenerate, 
her children, according to the beautiful laws of heredity, would 
also be sinners, degenerates, murderers ,and therefore it would 
be better if she had never brought them into the world. At 
any rate, it would be better if they died, and when she was 
brought to my office, she had tried twice to kill her- four chil- 
dren. That is one of the results. 

In another case there was a woman who began to detest and 
hate her husband with an absolutely maniacal, furious hatred, 
because after having three children he suggested that if there 
was a fourth pregnancy the foetus be removed. She began to 
build up all kinds of images that he was a murderer, had made 
her a murderess, hence would again create murderers and mur- 
deresses and degenerates and so on in the shape of children, 
and there was about the same process — she tried to kill him. 

In one case there was a neurotic woman who had an abor- 
tion the very first time she was pregnant. The abortion was 
performed in her home, and relatives living in the same house, 
of course, suspected something, and were nosing around, trying 
to find out. People with an empty mind pretending to be sci- 
entifically curious, want to know what we had for breakfast 
this morning. She felt that exposure would come. That one 
of them would talk about it. And she began to hate those 
people, moved from house to house to avoid them, and finally 



144 FOURTH SESSION 

managed to be turned into an asylum, from which she escaped. 
She came to consult me, and I managed to get a confession 
about those people, and then she felt freer. 

I don't know how many of these examples I could quote to- 
night if I had the time. 

What is the conclusion? Let us come to a practical con- 
clusion. Are we going to wait for parliament? I told you 
just what I thought of parliament. We must not wait. Hence 
what shall we do? Then again, let us state our facts without 
being ashamed of them. We should not be ashamed of any- 
thing biological anyway. The facts are that everybody who 
knows is practicing contraception or abortion. The facts are 
that information of the most unscientific, of the most un- 
reliable, of the most romantic kind is being given to anxious, 
hysterical women by other women who are quite as hysterical 
and quite as scared. It is exactly like the famous question 
asked me so many times, should we enlighten children about 
sex. Well, they do get enlightened by dirty little playmates 
of the same age who know nothing about it. Between the age 
of seven and the age of fourteen we learn about sex everything 
which is to be known which is not so. We learn the dirty 
romance of sex at the very early age. The question which is 
asked me all the time is this. Should our doctor and family 
physician impart clean knowledge about sex? Or should we 
keep our children pure by letting the gutter enlighten them? 
This is the choice. Most of us when we reach sexual majority, 
are enlightened about sex and the prevention of birth this way. 
We are learning from whispered conversations. Whispered 
advice of the most conflicting kind. It may come from people 
who know nothing about it. The family physician was not 
supposed to impart any of that information to us. Scientists 
are not supposed to do it unless they want to spend five years 
as boarders of Uncle Sam and maybe pay five thousand dollars 
after that, one or the other or both. 

In other words, what should be done? As I said before, I 
do not believe in waiting for parliment to make it legal. I 
believe in forming in every city, town and village, study circles 



BIRTH CONTROL 145 

at which every one of us shall receive absolutely accurate in- 
struction from physicians, preferably gynecologists and phy- 
sciologists in good standing, absolutely accurate information 
as to the physiology of sex and motherhood. After which some 
of us may not have to ask any other questions but can come to 
the conclusions immediately as to what manner of Birth 
Control and contraceptive means are the best for us. 

I also believe one thing, that the meaning of the perfectly 
insignificant operation called abortion should be made clear to 
all women who have been mothers several times, and who are 
planning to have no more children. As I said before, the 
operation is extremely insignificant, much less dangerous than 
having your nails manicured, or having your face shaved in a 
more or less antiseptic barber shop. As I say, very few 
women are killed by the operation of abortion as such, and those 
who die from it do so because of the fear that has been instilled 
into them, which has made them absolutely unfit to submit to 
any surgical operation without a vital disturbance to their 
blood stream, which generally lays some part of their body 
open in infection. 

You may tell me, of course, that we will be breaking the 
law by doing so. Well, there was a famous man who said 
that in many cases the law was an ass. And when we discover 
that the law can bring a great deal of unhappiness to tv/o gen- 
erations, and no happiness to any one, then in that case we 
might also say that that law is an ass. And if there is an- 
other psycho-analyst in the room, I would remind him that 
if he is afraid of breaking the law, the first psycho-analyst in 
the history of the science, old Doctor Socrates, also broke the 
laws of Athens, and was put to death. And I might tell the 
minister that Jesus once broke the law of the Caesars, and was 
put to death also. I might remind them that Galileo once broke 
the law of his native land and went to jail. And yet we are 
rather thankful to those three law breakers, and we have quite 
idealized one of them. Hence breaking the law should not bo 
the subject of too many fears. When you are feeling that you 
are breaking the law not to further your own personal private 



146 FOURTH SESSION 

selfish happiness, but the happiness of the community, then 
breaking the law is not a crime, but a public duty. 

Mrs. Mitchell: I would just like to say that I feel we 
should obey the law. Real patriotic Americans legislate and 
continue to legislate until we change things. 

The Chairman: I think the question of legality is quite set- 
tled in the principles and aims of the league as far as we are 
concerned. We know that we have to change the laws. There 
is no question of that. The law in the state of New York will 
allow physicians to give information to women or to men for 
the cure or prevention of disease. That is as far as we can go 
in the State of New York. And we are going to repeal the 
law. We are going to arouse the people so that they won't 
tolerate the law, so that normal, healthy women may have the 
information and keep themselves well. 

Mrs. Mitchell: I believe in Birth Control and do every- 
thing I can for it. I would like to say that in the middle 
western cities, these articles of prevention are sold and dis- 
played in all the drugstore windows. In Detroit, in Chicago, 
even in the little villages. I remember as a little girl seeing 
them, and there is an explanatory article in the window con- 
cerning them. I never even thought about it. 

Mr. Gibbons: I am a lawyer and am a good deal interested 
in the subject. The difficulty with changing legislation is that 
the average legislator is a great coward. He is willing to intro- 
duce any number of bills and even to work for them in the 
legislature and vote for legislation he does not know anything 
about, or care anything about but when it comes to taking any- 
thing off the statute books, it is a different matter. That is 
why the statute law in each state constantly increases and why 
American jurisprudence is coming to be the laughing stock of 
the world. Then we have the case law which is made necessary 
by the interpretation of all those various statutes by the judges, 
so that, even if it is rare for a lawyer to say it, people are jus- 
tified in breaking laws that become practically dead letters. 
The speaker here was referring to a law which is a dead letter 
in all parts of the country. We here on the Atlantic seaboard 



BIRTH CONTROL 147 

are tinctured with a remnant of puritanism and we are so 
puritanical about certain things. This is one of the things 
that fusses us, and there is a great deal that goes on under 
cover about which we don't know very much at all. In other 
parts of the country where they are franker, in the middle west, 
these laws are openly violated and nobody says anything about 
it. 

Dr. Goldstein: May I say in the first place, that I think 
that in dealing with the subject of Birth Control, we ought to 
recognize that we are discussing a subject that is exceedingly 
delicate, and to most of us sacred. The birth of a child, the 
conception of a child, is a sacred, mysterious, miraculous 
thing, and you and I ought to discuss it in that way. I think 
it is a dangerous thing to drag down the subject of Birth Con- 
trol to a low level. We want to raise it to the highest possible 
level, to the level where men and women will feel that we are 
allov/ing our pious sentiments to control us in the discussion 
and furtherance of a great social movement. In no other way, 
men and women, will you be able to win the support of the 
leaders of public opinion, those who are endeavoring to further 
social welfare. That is a very important point, it seems to 
me, to keep in mind. 

In the second place, we must not be discouraged because the 
laws at the present time prohibit us from doing certain things. 
Laws do change. Any one who has made a study of social leg- 
islation knows that laws do change, and that legislatures do 
pass new laws, and that even courts occasionally reverse them- 
selves. And courts are prepared to reverse themselves on a 
number of questions. I recall very well when Mrs. Sanger was 
indicted, and I know exactly what has happened, and I know 
that Mrs. Sanger is today serving as chairman of the American 
Birth Control Conference. This is evidence of the fact that we 
are making progress in our legislation, and that judges are 
coming to understnd what should be done in the interest of 
social welfare. I know that the judges in New York City at 
least recognize in Mrs. Sanger a great protagonist for social 
progress, and look upon her as an advocate of wider, and 



148 FOURTH SESSION 

higher, and nobler womanhood. That is the change that has 
taken place in this city within the last ten or fifteen years. 

May I urge also upon you the necessity of trying to win as 
far as you can the support of those who are really striving to 
lead the masses of mankind. Of course, I mean those who are 
standing in the pulpits of our country. After all, it is not a 
question of whether we shall or shall not have Birth Control. 
It seems to me that the principal thing we must do is this: to 
bring men and women who today are practicing the Birth Con- 
trol principle to the point where they will be willing to express 
themselves frankly in public, and where they will be prepared 
to say "That which we know and that which we are doing shall 
be given to and shall be done by the masses of men and women 
who today are suffering because of their ignorance." In other 
words, the whole question is simply this. Not, shall we have 
Birth Control, but shall you and I give to the great masses of 
the people in New York City the knowledge which we have in 
order that they may save themselves as we are doing, and in 
order that through saving themselves they may be able to save 
the future. That is the whole problem of Birth Control. 

DUTCH OPINION 

By Professor Herman M. Bernelot Moens 
Anthropologist^ Holland 

WE SAY in the Dutch language ... I am not so familiar 
with the English language as with the other language, 
so I have difficulty in translating it. But the significance is, 
to begin directly with the real thing. In Holland we have no 
Statue of Liberty, but we have a Birth Control clinic. That 
clinic was founded already in 1875. To see what you can do 
here, I think you have to find out, if you have not already done 
that, what are the real enemies, and why can't you do here as 
we do there. What are the enemies? I think, generally, 
ignorance, and more directly the church and the government. 
The government is not what it should be, and the church is not 
as it should be. I think if they were as they should be, you 
could have clinics here too. What are you going to do about 



BIRTH CONTROL 149 

it? It is all right to talk about it, and say it is wonderful. 
But don't talk about things. Do them. What can be done? 
I found here that there was that section 211 of the Federal 
Penal Code that can be used for nearly everything. For things 
that are obscene and for things that are not obscene. How do 
I know about it, as a Hollander who comes to this country not 
having studied law? 

I came to this country to study races and mixed races, as an 
anthropologist, which I have been doing for years. So I did 
not know much about these things, and of course when I came 
in I saw your Statue of Liberty, and I heard always about the 
land of the free — liberty, equality, fraternity, democracy, jus- 
tice, and all the rest, and nobody informed me of any law. It 
happened I had been studying mixed races, of course I studied 
the colored races too, white, black and all kinds of beings. 
It happened I came over before the war, introduced by my 
government, of course, and my legation, and thinking that I 
was well known. The idea came that here is a white man who 
studies negroes and does not make any money. He must be 
paid by the German Emperor, and the Holland people were 
called Dutch people, and so of course a kind of German. So 
having been sought out, and there was nothing to find out, 
they came to my home to look my things over, without any 
search warrant. There was nothing to find, as I thought, when 
they stole things during the investigation by representatives 
of the United States department of Justice, and what did they 
take? I had a whole photographic collection of these mixed 
races, of course. They were all made by government officials 
and government institutions in this country. Some of them 
were nudes. Two of those nudes have been stolen. These 
nudes have now already been published, some with a black 
band, and some without. They have been described by some 
prominent American Anthropologists as very line photographs 
and as artistically, faithfully done. For those two I have been 
indicted for having exhibited obscene pictures; those pictures, 
taken by those men who came to look in my home for a spy. 
Now the question is to penetrate people with what is obscene 



150 FOURTH SESSION 

and what is not. In Holland we consider it moral to have 
children when we want them, and we can take care of them. 
And we consider it immoral to have children when we don't 
want them and cannot take care of them. So I think that is the 
right point of view. 

Now, a thing that may help your movement here, is to con- 
sider what was the result of the persecution or prosecution, just 
as you will call it, that I had. After it there was a lecture here 
in the Sunrise Club about science and prudery. All the presi- 
dents of the different Netherland Societies were there, and 
many prominent people, and we formed the "Science and Arts 
Protective Society" and I think that society is very necessary 
and may do a tremendous deal of good working together with 
the Birth Control movement. The Science and Arts Protective 
Society means — I will read it to you "To secure such amend- 
ments of the present laws relating to alleged obscene liter- 
ature." We want to define specifically what constitutes ob- 
scenity. You know probably that Postmaster Will Hays will 
bring in Congress a change from that vicious Comstock law 
so that there will be defined exactly what is obscene. How can 
you protect yourself when you don't know it? I saw the 
photographs made. I did not know that they could attack me 
for them. It is ridiculous, of course. But they do it. So now 
I know it, and won't make any more photographs as long as I 
am in this country, and as long as it is not right. 

The second point in the Science and Arts Society is to work 
for the education of the public in matters of sex and to over- 
come the unwholesome prudery which creates deplorable 
results. 

The third and last point, to defend persons unjustly accused 
under the laws while they remain in the present objectionable 
condition. 

I think this is our hope, all those who are in it, and who 
do it for the love of it, and not for pay, that we will work 
together with the Birth Control movement. And we hope that 
the result will be that you will have beside your Statue of 
Liberty a Birth Control clinic, or many of them, in this country. 



BIRTH CONTROL 151 

Miss Mary Winsor 

IF I were to take the subject assigned to me on the program, 
"Birth Control Movement in Europe" it would be so vast 
that like Lord Bacon I should take all knowledge for my 
province. In the limited time that has been assigned to me, 
I purpose to restrict myself to Birth Control in one part of 
Europe, and that is Austria, German-Austria. For two reasons. 
In the first place, we have been so long out of touch with what 
our colleagues are doing in that part of the world, that it is 
important for us to get into touch with them again. The 
Birth Control movement is an international movement, and is 
not properly conducted unless we know what has been done 
all over the world. And, in the second place, I had the oppor- 
tunity of being six weeks in Austria, principally in the city of 
Vienna, and made quite a thorough study of it. 

No one can understand what they are doing in Austria who 
has not some idea of the terrible conditions there. I propose 
very briefly to give you a little background of what is going on 
there. 

As the train from Paris crossed the Austrian border, we were 
standing on a siding. We saw a third class train full of peas- 
ants standing there also. We were sitting in the restaurant 
car eating breakfast. These people were looking in through 
the window, glaring steadily, looking at the food we were 
eating in the restaurant car. 

I went all through Vienna, through the working class dis- 
tricts. You saw faces there that did not look human. They 
did not look as if they were now living. These people had a 
fixed look, with eyes staring and an expression as if they were 
coming out of a bad dream, as if they had died and were buried 
and came back again. They did not look sane. 

We went through the hospitals. We saw little children, 
hundreds of them, unable to lift themselves up, with little arms 
and legs like tooth picks. We saw one little boy with his legs 
braced up with heavy leathern braces, supporting himself on 
crutches, a child with his little twisted body that would not 
grow up. The doctor said, "If you strike this boy on his arms 



152 FOURTH SESSION 

like that, his bones would snap." The children that are being 
born are being born in that condition. 

I have some leaflets of the Austrian Birth Control League. 
They call attention to the fact that in Vienna where the worst 
conditions prevail, the majority of the children are kept alive 
through the help that is sent in from foreign countries. 

An investigation undertaken among the 284,000 children 
found only 66 of them that were even normally nourished; 
75% of them are tubercular; 22% had died in the first year 
of their life. The hospitals were filled with children in this 
bone condition. New born children are being wrapped up in 
newspapers, because there is nothing else to wrap them up in. 
They have no baby linen, they have no warm water to wash 
them in. They have no clothes. 

When you speak to the Austrian people about their future, 
their faces settle into heavy lines of discouragement, because 
the conditions are so terrible, the rate of exchange is so low 
that they cannot even escape from their miserable country and 
go somewhere else. 

That probably explains the lengths to which the Austrians 
are going in their demands for Birth Control. I do not offer 
this as propaganda. I am simply giving information about 
what their condition is. They are preparing to give out 
information, legally, about prevention of conception. There 
is nothing to prevent them except an obsolete press law that 
forbids such advertisements being put into the papers. Other- 
wise they are at liberty to establish clinics for the prevention 
of conception, but they want to go further than this. They 
want to be protected legally to perform abortions during the 
first three months of pregnancy, if such operations are per- 
formed by a physician. That is what they are struggling for. 
The conditions in Vienna I think produced this demand. They 
simply feel that it is unsafe for women to bring children into 
the world. The birth rate has fallen off terribly in Austria. 

The Austrian Birth Control League undertook some inves- 
tigations among midwives. One midwife of many years prac- 
tice told them that ten years ago she had every month an 



BIRTH CONTROL 153 

average of about thirty-one confinement cases. At present she 
has only from one to two confinement cases a month. The 
women who come to her come only to ask for advice as to how 
to prevent births and conception. Indeed, they are not even 
asking that, because, as another midwife in the rural districts 
said, the peasant wives knew all about such methods anyhow 
and were practising them. 

We have heard a great deal about what happens here among 
the working classes. In Austria it has swept through every 
class, the poverty and the misery, with the exception of a very 
few profiteers. 

We were taken to see Martha Hainisch, one of the leaders 
of the Women's Rights Movement. She showed us a little 
room in her house where she slept, dressed, did her work and 
received her visitors, because that is the only room in the 
house that she can afford to have heated during the winter 
months, and she said, "This is where the mother of the presi- 
dent of the Austrian Republic lives." So you can imagine how 
widespread the misery is. They are simply afraid to have 
children, to increase the population. 

The Birth Control movement is being conducted by some of 
the leading physicians in Vienna, prominent citizens. I had 
the privilege of having a long talk with Johan Fersch, who is 
president of the Birth Control movement. He is a working 
man, born of a working class family of eleven children, and 
an active member of the Socialist Party, which is important, 
as the Socialist Party is very powerful in Austria and Germany. 
There are two aspects of Birth Control. One is what Mr. 
Maurer dwelt on, the economic aspect, and the other is the 
freedom of women, and although Johan Fersch is a working 
man and a socialist, he told me that important as the economic 
aspects are, he considered the freedom of the women more 
important still. That is the spirit in which this is being con- 
ducted. He is an apostle and a light to the women of Austria. 

They were able to get Birth Control bills introduced into 
the Parliaments both of Austria and Germany. They were 
pushed by the Social-Democratic Party, not as a party, but by 



154 FOURTH SESSION 

members of the Social-Democratic Party. They were intro- 
duced in Austria by Adelle A. Poff. I think that it is most im- 
portant for the propaganda here that we women realize that 
we are voters. We shall have to conduct this movement slowly 
and in an educational way, and if you want to educate people 
the best way to educate them is through politics and in 
political parties. I think it would be advisable when we get 
our Birth Control League started to find out which of our 
members are active in politics and make it their business, 
both men and women, to work for Birth Control within their 
respective parties, to bring those issues to the attention of the 
party leaders. They won't thank us for it, but we will force 
their attention to it to the end that they will officially indorse 
it, and then, in the next presidential election, we can conduct 
a tremendous campaign all over the country, with the advantage 
of having this come to the forefront of political questions and 
also of making the stupid party platforms of the Republican 
and Democratic parties have a little human interest and take 
up one of the great, fundamental questions. 

Johan Fersch told me "Wherever we go, we take the largest 
hall or the largest theatre and that is not enough. It is 
crammed with the people, especially the women who are inter- 
ested in this." It is very significant that they should have so 
much success in the provinces. In Vienna, though the Catholic 
element is strong, there are a great many Jews who are more 
open-minded to this question than the Catholic Church. I had 
to touch on the Catholic question because those questions are 
so in evidence in Austria. The provinces are Catholic, strongly 
Catholic, yet Johan Fersch told me they had such tremendous 
success in those provinces, which shows how thoroughly the 
women are roused up to this subject. 

I followed the papers very closely, as I do whenever I am 
in a foreign country, and you could not pick up an Austrian 
paper without perhaps three times a week seeing reports of 
those terrible birth control cases, women who in desperation 
had performed abortions and were brought into court. The 
present law which they are trying to alter is very severe. If a 



BIRTH CONTROL 155 

woman undertakes such an operation and it is not successful, 
she can be given from six months to a year in jail. If the 
operation is successful, she can be given from one year to 
five years at hard labor. I saw the case in the paper of a 
young unmarried girl. She and the midwife were brought into 
court for having performed an operation. She was absolutely 
destitute. She had no place in which to live, and she said that 
she thought before the poor bird came that a nest should 
be prepared for it, and that is why she had attempted to do 
away with that unborn child because she had absolutely no 
place in which to lay her head. That, however, did not deter 
the judge from giving her a prison sentence. 

Johan Fersch told me that the accusation that is brought 
against his movement just as it is here, is that they want to 
help disreputable girls, that they want to help prostitutes and 
that sort of thing. He is conducting some of these court cases. 
One was the case of a mother of nineteen children, who in 
desperation had attempted to perform an abortion as she 
felt she could not endure a twentieth child. The woman was 
in such condition that they had to take her to court in a 
carriage. She could not walk. Johan Fersch was conducting 
her case. He turned to the judge and said, "You accuse us of 
helping disreputable girls. Look at this mother of nineteen 
children. Stand up." The woman struggled to her feet. She 
was as white as a sheet and shaking. She could scarcely 
stand. "This is one of the disreputable girls we are trying to 
help." He did move the judge so that he only gave her a few 
months in prison instead of five years. 

I have some of the pamphlets that are published by the 
Austrian League. I will read you one or two little sentences 
from them. Johan Fersch himself is the author of a dozen 
novels dealing with the Birth Control question. One is called 
"The Crucifixion of Love," describing the adventures of a 
young married couple. The other is called "The Romance of a 
Childless Couple." And he and his wife, a most charming 
and beautiful wife, have taken up the position that they will 
have no children until this curse of unlimited families is re- 



156 FOURTH SESSION 

moved from the rest of the country. They are denying them- 
selves children so that they can give themselves up to this 
work. And he brings out this point : that under the old regime 
in Austria, Birth Control was combatted in the interests of 
imperialism and militarism. He goes on to say, "Compulsory 
maternity is a form which is really a conscription of mother- 
hood." That, I thought, was a very striking and good point. 
Then he says, "It is ridiculous in a state to take such pains to 
protect the embryo, but not to protect the complete life. The 
embryo is protected, but when the child is brought into life, 
the state gives it no care and no protection." "We are accused 
of being unnatural, but," he says, "it is the government that 
is unnatural, because the government is inconsistent. The state 
commands the creation of life, and does nothing to protect that 
life when it is brought into the world." "It is unnatural to 
fertilize a churchyard," "It is unnatural to add those we love 
to starvation, to misery and to early death." He says "It is 
ridiculous to preach this sanctity of human life, when blood 
has been shed in torrents on the battlefields of Europe." He 
says "The people who are preaching the sanctity of life are the 
very imperialistic and monarchistic and clerical influences 
who were most eager to send human beings to shed their blood 
during the war. It is they now who preach the sanctity of life." 
He takes up the question of its being immoral, and he says very 
truly "Conceptions of morality change from age to age and 
from country to country. We should consider moral what is 
necessary and expedient for us in our daily existence." "The 
birth of a child that is born into the world into suffering, that 
is immoral." "Morality should not have to be enforced by 
such laws." He speaks also of the interest of the state, the 
point that Mr. Maurer pointed out, that the state has no inter- 
est in, no value for beggars, for sick persons, and for crim- 
inals, and it is to the interest of the state that we should supply 
it with healthy children. As for the increase of prostitution, 
that these laws forbidding the spread of knowledge prevent 
many girls from early marriages, and drive many into prosti- 
tution, and therefore these laws against Birth Control increase 



BIRTH CONTROL 157 

prostitution. Then he goes on to plead for the right of abortion 
in the first three months. He says that the germ is not life, 
but it is murder to deliberately destine your children to misery, 
to hunger, to suffering and starvation, and to a hurried and 
miserable death. 

Miss Rowe: This morning we sent a telegram to the arma- 
ment conference in Washington. In order to explain our posi- 
tion more fully, it was decided to send on to that conference 
an open letter, as follows: 

To the Conference on Limitation of Armaments, 
Washington, D. C. 

This Conference desires to draw attention to the vital im- 
portance of the population question from the point of view of 
national security and world peace. 

If ever recurring wars are to be prevented the people in 
each country must be able to live in reasonable comfort within 
their own borders. This can only be secured by a well bal- 
anced control of the birth rate. In most countries such a 
control is already being practiced by a minority; but the 
masses are still continuing to multiply their numbers regard- 
less of their children's prospects in life, regardless of the 
hideous suffering that must ensue when rival races are driven 
to fight with one another for room to live. 

We therefore urge that all nations should publicly recognize 
the supreme importance of well distributed Birth Control 
among all classes as a means of raising the standard of human 
life and of guaranteeing the peace of the world. 

Motion carried to send open letter. 

Miss Rowe: There is also a petition to be sent to the Sur- 
geon General of Public Health Service at Washington. 

To the Surgeon General Public Health Service, 
Washington, D. C. 

We, the First American Birth Control Conference do petition 
the Surgeon General of the United States Public Health Serv- 
ice to undertake medical research into contraceptive methods 
for the control of disease and publish such reports for dis- 
semination through constituted health authorities; and 



158 FOURTH SESSION 

We further petition the Congress of the United States of 
America to make an appropriation in sufl&cient amount to 
undertake such studies and to publish such reports. 

Motion to send petition carried. 

Miss Rowe : There is another petition to be sent to Governor 
Miller and the governors of each state, as follows: 

To His Exellency Nathan Miller, 

Governor of the State of New York, Albany, N. Y. 

We, the First American Birth Control Conference do petition 
that: 

You will recommend to the next session of the General 
Assembly of the State of New York that a Commission be 
appointed to investigate the decline of the birth rate. 

Motion to send petition carried. 

Miss Rowe: There is another resolution to be put before the 
conference as follows: 

While desiring a decrease of the world birth rate in general, 
this Conference is well aware that this should take place on 
the part of individuals whose progeny would less contribute 
to a better race and that indeed on the part of many persons of 
unusual racial value that their birth rate is now too low. 

Therefore, be it Resolved, that we advocate a larger racial 
contribution from those who are of unusual racial value. 

Dr. Johnson: I should like to say one word about this mo- 
tion. If this prevails it seems to me it would be a very great 
step forward. It makes the work of this conference acceptable 
to eugenists. I drafted that resolution from a eugenic point of 
view. Some eugenists have felt rather alienated from the Birth 
Control movement for fear that the Birth Control people would 
not be willing to pass such a resolution. It seems to me that 
the passage of such a resolution would be of great significance. 

Mr. Lewis: I believe that to advocate the increase of the 
number of children of those people who do not want any is not 
bringing us forward. I think we are advocating Birth Control 
only for those who want it. I think that is an individual matter. 
I do not believe that the resolution would be of any benefit to 
the Birth Control movement. 



BIRTH CONTROL 159 

Dr. Robie: I do not wish to advocate more children for 
those who do not want them, but those who heard my contribu- 
tion to the discussion this morning will remember that I advo- 
cated that the fit be so impressed with these matters that they 
would want children. That is a part, I think, a distinct part of 
the Birth Control movement. Not only scientific application of 
chemical or mechanical contraception, but the psychological 
removal of the inhibitions that lead to the diminution of pro- 
geny among the more fit of the community. 

Motion carried. 

Dr. Robie: I wish to present the following resolution: 
"Whereas the proposition has been laid before Postmaster Gen- 
eral Hays by the Voluntary Parenthood League that he recom- 
mend to Congress the revision of the postal laws, Resolved, that 
this American Conference for Birth Control, urges Postmaster 
General Hays to act favorably on this proposition as a matter 
of postal progress and as a service to modern science, welfare 
and justice." 

The Chairman: I think that is to be considered by the 
resolutions committee. If it has not been brought up by the 
committee there must be some reason for it. We have not 
taken up the federal law. We think that this organization be- 
lieves that it is first essential for us to go into the states, state 
by state, and educate the people by having direct personal in- 
formation from their doctors, before we begin to make a dis- 
semination of printed and written matter circulated through 
the mails. That is the position our league has taken. We are 
going to take up the federal law, but as a secondary matter, 
and for the present we are out to get the information in a 
private way, in a more personal and direct way, to the women 
of the country. 

Mrs. Hooker: My feeling is that in order that our object 
should be attained we should work along one line. If at the 
moment it would be possible to repeal the federal law, I am 
not at all sure it were wise for us to do it. We would have 
an almost infinite amount of quack literature sent through the 
mails. We would have all sorts of specialists who would de- 



160 FOURTH SESSION 

vote their time to advertising their specific remedies which 
might in many cases be misrepresented and utterly ineffective. 
We might duplicate the situation we now have with regard to 
the use of venereal prophylactics. My feeling is that our move- 
ment should devote itself to working from state to state until 
w^e find it advisable to approach the federal statute. I think 
when we have a post in each community, when we have made 
our propaganda understandable, when our position has become 
defined, that it will then be possible to repeal the fderal law 
without danger, but I think it would be much better to keep 
our objective perfectly simple, perfectly single, and to direct 
personal work as a preliminary and as a basis for more wide- 
spread work which will possibly follow after. I say that in 
view of the fact that for instance, in our suffrage work when 
the division of opinion arose there was always room for tv/o 
opinions and while we have the Voluntary Parenthood League 
working for one objective, the repealing of the federal law 
and the Birth Control League working for another objective, 
I think we better keep to our objective. 

Mr. Lewis: I think it is regrettable that the last resolution 
was offered after the meeting had been called to an end, because 
I think it is too serious a matter to be discussed in a heated 
moment, and I honestly and firmly believe that this conference 
is of more importance to the people of the United States than 
the conference in Washington on the armament question. And 
I do not think that we ought for a single moment to take under 
consideration a resolution that will possibly cause the slightest 
hitch in carrying out the purposes of this conference. As much 
as I am in favor of having the federal law repealed regarding 
the dissemination of information on contraceptive metliods 
through the mail, and as I was ready and willing to second the 
resolution, I say now that we dismiss this resolution and ad- 
journ this meeting before there is any harm done to the glorious 
beginning which has been so wonderfully and admirably 
started by Margaret Sanger. 

Mrs. Bennett: Madam Chairman. There is one impression 
that I have gotten from this conference, and that is this. That 



*i 



BIRTH CONTROL 161 

there is little information about methods of contraception by 
•members of the medical profession. It seems to me that the 
important thing for us to do is to get after this thing, or its 
root, in a scientific way, and concentrate our work upon getting 
public opinion back of scientific information in methods of 
contraception. The way to do this is not in my opinion by 
federal action. I am in favor of any group that is starting any 
kind of work for Birth Control. I entirely support Mrs. Sanger 
in her contention that we should keep on a steady and well- 
defined path, and not allow this organization to go off in reso- 
lutions indorsing the action of any other organization working 
for presumably the same thing that we are working for. One 
thing I am sure of and that is, that we have not yet definite 
scientific information. We cannot get that information unti 
the medical profession is aroused to make a scientific inves 
ligation, and the way to get that done is not by liberating al 
over the country quack literature through the repeal of federa 
laws, but by getting public opinion worked up through indi 
vidual work in individual states to back up the medical pro 
fession and give them more backbone than they ever had be 
fore. When we get scientific information it will be time enough 
to repeal the federal laws, then we can confront with scientific 
information the information dealt out by quacks. 

Mr. Jennings: In answer to the point which Mrs. Sanger 
made that the aim of this newly formed league was to bring 
this information, the scientific contraceptive information as 
quickly as possible to the people, I wish to say that it is the 
announced policy of the Voluntary Parenthood League, and 
has been for a long long time, that we stand exactly for that. 
We stand both for federal and for state legislation but we put 
the federal legislation first because the passage of the federal 
law will not only free transportation of contraceptive informa- 
tion but it will clear this whole subject in twenty-four states 
where there is a population of forty-six million people, and 
will open the way for an immediate establishment of contra- 
ceptive clinics in those states where the physicians can give that 



162 FOURTH SESSION 

personal physician-to-patient service which Mrs. Sanger em- 
phasizes. 

Another point which should come to your attention in rela- 
tion to the matter now before Postmaster General Hays, that 
proposition laid before him provides as follows: That no 
printed information or methods of preventing conception, and 
no ingredients, compounds, or implements for preventing con- 
ception, shall be transportable through the mails of the United 
States, except such as bear the indorsement of a duly licensed 
physician or public health authorities. If he carries out that 
proposition and thereafter does his best and gets Congress to 
do its best to pass it to protect the health of the people by 
having nothing legal except what does bear medical indorse- 
ment, then if the medical profession of this country will rise 
to the occasion as they have in England, then Dr. Stokes' "Wise 
Parenthood," which is a textbook on Birth Control in England, 
will be sent all over the country and enlighten the people of 
this country. 

Mrs. Morgan: As I understand it, the federal law forbids 
only the literature from going through the mail. If that were 
so, and the federal law would be passed before the state law, 
we would be in a position of some quack or nurse in New Jersey 
writing to some woman in New York, but still she could not 
have her own physician's oral information in her state, neither 
could you have clinics which would be open. 

Mrs. Tuttle : I move to lay the resolution on the table. 

Motion to lay on the table carried. 

[Adjournment] 



THE PUBLIC MEETING 

"IS BIRTH CONTROL MORAL?" 

Park Theatre, Friday Evening, November 11, 1921 

ON THE Programme of the First American Birth Control 
Conference, it was announced that a public meeting 
would be held on the evening of Sunday, November 13, at 
which Dr. Karl Reiland, Rector of St. George's Church would 
preside and the speakers would be Mrs. Margaret Sanger 
and Mr. Harold Cox. At the appointed time a large 
audience assembled, but a police captain, instructed by 
a dignitary of the Roman Catholic Church, took upon 
himself to close the meeting and prohibit the speeches. 
Because they attempted to make some explanation of this un- 
expected interference, Mrs. Sanger and Miss Mary Winsor 
were arrested, but were discharged immediately on their ap- 
pearance before the court, as having been guilty of no legal 
offense. Very hurriedly, arrangements were made for a post- 
poned meeting on the following Friday, November 18, when 
a large audience again assembled. This time there was no 
police interference and speeches planned for the earlier meeting 
were delivered. Mrs. Juliet Barrett Rublee welcomed the 
audience, and was followed by Dr. Lydia de Vilbiss, who intro- 
duced the Chairman, Dr. Reiland. After his introductory re- 
marks he presented Mr. Robert Marsh, the attorney for the 
Conference, who made a clear statement of the legality of the 
proceedings and denounced "the outrageous violation of Amer- 
ican liberties" which had occured when the police had inter- 
fered with the holding of the meeting on the previous Sunday. 
It may be added here that Commissioner Hirshfield — for the 
Mayor of New York — undertook an investigation of the action 
of the police in breaking up the meeting and making the ar- 
rests.' Up to the end of September 1922, no report had been 
made and no disciplinary action taken. 

163 



164 PUBLIC MEETING 

The subject of discussion at the public meeting was "Is 
Birth Control Moral?" and the chief speakers were Harold 
Cox and Margaret Sanger. 

Harold Cox 

(Editor "The Edinburgh Review") 
T PROPOSE, first of all, tonight to make to you exactly the 
same speech which I had prepared to make last Sunday 
night, and then I propose to say a word or two about another 
and even broader subject. 

The question I submit to you tonight is this: Is Birth Con- 
trol Moral? Now, when any problem of morality is put to 
you or whether any particular action is right or wrong, the 
first question you have to ask yourselves is. What is the pur- 
pose of that action? For, if the purpose be wrong, the thing 
itself must be wrong. What, then, are the purposes of Birth 
Control ? 

The first purpose of Birth Control is to preserve the health 
of the mother. If a woman has children as repeatedly as 
Nature permits, her health cannot be preserved. I have 
heard of women in our slums in London, married women, 
who say, "Our lives are one long disease." Is it desirable 
that that should continue indefinitely? Is it desirable that 
thousands, even millions, of married women in the poorer 
quarters of all our town should not know for 10, 15, 20 
years what it is to have a whole year of real health? That, 
then, is the first purpose, to preserve the health of the mother. 

The second purpose is even more important. It is to pro- 
mote the health of the child, for here you have the new gen- 
eration involved. The children that are born today make up 
the new generation. If children are born so rapidly in suc- 
cession to one another that the mother cannot give proper 
care to each, it is impossible that they should be brought up 
healthy children. Attempts are made in many countries to 
escape from that difl&culty by establishing public institutions 
to assist in the nurture of the children; but I contend that no 
public institution is an adequate substitute for a mother's 



BIRTH CONTROL 165 

care. I contend, further, that you can find no higher moral 
purpose in life than the rearing of healthy children to be the 
men and women o^ the next generation, the fathers and mothers 
of generations to come. 

Those are two purposes which I think you will agree with me 
are moral purposes. 

The third purpose of Birth Control is to raise the gen- 
eral standard of life throughout the whole community. Now, 
that is impossible as long as the families of the poor con- 
tinue so large. In the poorer districts in all countries the 
children are brought up in poverty, without sufficient food, 
without sufficient training, without sufficient opportunities of 
play; they are turned out at an early age to earn money, and 
the absurdity of the thing is that though they go out to earn 
money in order to assist the family income, their competition 
in the labor market actually lowers the wages of their own 
parents. 

Again, many people try to escape from this evil of the mul- 
tiplication of poor children by all sorts of State subsidies, free 
meals for school children, for example. Again I say that you 
are doing a thing which produces worse results than you antici- 
pate, for you are destroying the link between parent and child. 
Only a little while before I left England a friend told me that 
she had heard some of the women down in the East End of 
London — that is our poor quarter there, as here — saying, 
"Well, our kiddies aren't our own any longer; they belong to 
the County Council now." I contend that you break the most 
fundamental of human relations if you substitute the charity 
of the State for the duty of the parent. 

What, then, do the advocates of Birth Control propose in 
order that we may have a higher standard of life throughout 
the whole community? They propose that exactly similar 
measures should be taken to improve the standard of the 
human race that a skillful gardener takes to improve the qual- 
ity of the flowers that he grows. He sows his seed widely and 
thinly, — he leaves plenty of space for each seedling to grow, 
takes care of each plant as it appears above the ground, and 



166 PUBLIC MEETING 

the result is the production of a fine flower. But is not the 
production of fine human beings an even higher moral purpose 
than the production of fine flowers? 

And the fourth purpose of Birth Control is from some 
points of view — especially in view of the present con- 
dition of the earth — even more important. The fourth pur- 
pose of Birth Control is the prevention of war. 

The surface of the earth is limited and by no magic can we 
increase that surface; but the power of multiplying human 
beings is unlimited, — you can go on multiplying them in- 
definitely as you can multiply any plant or any race of animals 
— and if you continue to do so, if you continue to multiply 
the human race, disarmament agreements will count for noth- 
ing, because as the different races continue to multiply they 
will be brought up against the hard fact that there is not room 
enough on the earth for all of them and then they will fight 
for space to live. You may take it as certain that the majority 
of men would sooner kill one another than starve themselves. 
And what the opponents of Birth Control, in effect, say is that 
it is the duty of women to go on breeding the men to kill one 
another. 

Well, that danger of war, I say, is perhaps the most serious 
of all the questions before us because it is getting pro- 
gressively more imperative, more dangerous progressively, 
because the earth is so full that a small rate of increase in any 
country will give you a large annual increase of population. 
That is a very simple proposition which a great many people 
fail at first sight to realize. You can see it in a moment if I 
put it to you this way: that one per cent, on a million 
yields a larger income than ten per cent, on a thousand. If 
you have got a small population, you can have a large birth 
rate; if you have got a large population, you cannot have a 
large birth rate because you will have so many millions of 
children produced that there won't be room enough for them 
all. You must reduce the birth rate as the population grows. 

How are you to do it? There are only two ways: You can 
either have fewer marriages — ^that is what Malthus suggested 



BIRTH CONTROL 167 

many years ago, suggested that marriage should be postponed 
— or you can have fewer children to each marriage, — ask 
people to marry early and live happy lives together but not 
fo have so many children. 

I contend that fewer marriages mean, in practise, more 
prostitution; and fewer children per marriage mean more 
happy homes. 

These, then, are the four purposes of Birth Control: the 
preservation of the health of the mother, the promotion of the 
health of the children, the establishment of a higher standard 
of life for the whole community, and finally, the prevention 
of war. I venture to say that no one will deny that all these 
are moral purposes of highest order. 

Some people, however, declare that though the purposes are 
moral the methods proposed are immoral, and they begin by 
saying that Birth Control is an interference with the processes 
of Nature. Well, I confess I find it a little difficult to be 
politely tolerant when that argument is used, for what is the 
whole of human progress but an interference with the processes 
of Nature? It is not natural to wear clothes; it is not natural 
to live in houses; it is not natural to apply science to cure 
disease; marriage itself is unnatural. The truly natural man, 
the savage in Central Africa, waits for the woman he wants, 
stuns her with his club, and carries her off to his cave; that 
is real Nature. And if these idealists of what they call "the 
processes of Nature" were true to their own convictions, they 
would get up and advocate that we should all go back to our 
primitive nudity and to our primitive savagery — and then there 
perhaps would be a case for the police to interfere. 

Well, not content with that argument about Nature, they 
proceed to quote the Bible, and they quote a particular text 
from the Book of Genesis which enjoins persons to whom the 
command was given to be "fruitful and multiply and replenish 
the earth," and they have gone on quoting that for centuries, 
and very few people have taken the trouble to look up the 
circumstances under which that command was given. It was 
given to Noah and his three sons and their four respective 



168 PUBLIC MEETING 

wives immediately after the Flood. Noah, I may remark in 
passing, was 600 years old at the time and his eldest son was 
90. To these eight people of rather extended age the command 
to be fruitful and multiply was given at a time when all the 
earth was empty; and yet you have ecclesiastics getting up and 
quoting that command as if it applied to London and New 
York today. 

Today it is not numbers that we want to increase, but 
quality that we want to improve; and perhaps it may be worth 
while to remind you that that elementary proposition was 
understood a great many centuries ago by some of the people 
who contributed to the Bible. You will find in the 6th Chap- 
ter of the Book of Ecclesiastics these words: "Desire not a 
multitude of unprofitable children, neither delight in ungodly 
sons; though they multiply, rejoice not in them, for one that 
is just is better than a thousand." 

But if parents are to have fewer children they must practise 
Birth Control. I contend that it is impossible to expect healthy 
young married couples to abstain altogether from the funda- 
mental relation of married life, except at intervals of two or 
three years, and then to live entirely as celibates after they 
have had two or three children. The thing is utterly inhuman 
and impossible and it would break the happiness of millions 
of married couples. I contend that the love of man and woman 
is one of the most moving and also the most ennobling of 
human instincts, and I cannot do better at this point than quote 
the words of the King's physician, one of the most dis- 
tinguished physicians in London, Lord Dawson, who, speaking 
recently at a meeting of the Church Congress, said: "Life 
without the love of man and woman would be like the world 
without sunshine." 

Therefore, I contend that Birth Control is moral because it 
renders possible the continuation of that sunshine, because it 
renders possible the attainment of a higher standard of life for 
mother and for child and of a higher standard of living for 
the whole community; and finally, it is moral because it pre- 
vents the otherwise inevitable recurrence of devastating wars. 



BIRTH CONTROL 169 

Ladies and gentlemen, that is the speech which I had in- 
tended to make on Sunday night last. I was prevented from 
doing so by an incident to which I wish briefly to refer. I 
am not a citizen of the United States and I have not the right, 
nor have I the desire, to comment upon or interfere in your 
purely domestic matters; but issues are sometimes raised in 
one country which affect all countries, and among such issues 
is the issue of freedom of speech. On that issue I feel that I, 
as an Englishman, am entitled to express my opinion to you as 
Americans, for we share not only the same language but the 
same traditions of government and of liberty; we inherit to a 
large extent the same history. King Henry VIII, who liberated 
England from the domination of Rome; Queen Elizabeth, in 
whose glorious reign was first developed that overseas move- 
ment of the English race from which your nation sprang; 
Cromwell, who fought for constitutional liberty; Milton, who 
defended liberty in words that will live for all time, — all these 
and countless others whose names may be forgotten but whose 
works still endure, all these are a part of your history as well 
as of mine, and in the name of this glorious heritage which we 
together share, I appeal to you not to permit the great principle 
of liberty of speech to be trampled under foot in any part of 
your country. 

I hold that there is no liberty so important to the world as 
liberty of speech, for without freedom of speech progress is 
impossible; unless men and women are free to criticize insti- 
tutions and practises which they hold to be wrong and free to 
advocate changes which they hold to be desirable, there can 
be no effective movement for reform or progress of any kind. 
The incident of last Sunday night shows how easily this funda- 
mental liberty may be imperiled, although it is expressly 
enshrined in your own constitution, and may be imperiled by 
the very officials whose duty it is to defend the law and the 
constitution. 

I speak to you on this subject because it does not affect 
America only, because what happened the other night is a 
warning to all nations. Fifty years ago we in England im- 



170 PUBLIC MEETING 

agined that the battle of liberty had been won for all time. 
Tennyson wrote, if you remember, of freedom broadened down 
from precedent to precedent; he may have been right at the 
time when he wrote, but he was wrong for the future, — he was 
wrong in assuming that freedom would automatically progress. 
No progress is automatic. Each advance that the world makes 
has to be won by fresh effort, by the efforts of those who see 
ahead, as Mrs. Margaret Sanger has done and who devote 
their lives, as she has done, to working for the progress of 
mankind. 

And let me give you one further warning: Not only is it 
impossible to hope that progress will be automatic, but even 
the maintenance of the freedom you have won is not automatic. 
As one of the most brilliant English orators said many years 
ago, "the price of freedom is eternal vigilance," and he was 
perfectly right, for in all countries there are enemies of free- 
dom; monarchs, politicians and priests, who for one cause or 
another wish to deprive their fellowmen and women of liberty 
of action, of liberty of speech, and even of liberty of con- 
science. There lurks a danger which, if we shut our eyes to it, 
may destroy the advance achieved by centuries of effort. I 
repeat, the price of liberty is eternal vigilance. 

And therefore, to you, as Americans, I, as an Englishman, 
appeal ; I appeal to you to exercise that eternal vigilance which 
is the price of liberty; I appeal to you to defend your liberties 
by whomsoever they are attacked, and I make this appeal to 
you not for the sake of your own country only, but for the 
sake of all mankind. 

Margaret Sanger 

President, American Birth Control League 
nnHE meeting tonight is a postponement of one which 
was to have taken place at the Town Hall last Sunday 
evening. It was to be the culmination of a three day confer- 
ence, two of which were held at the Hotel Plaza, in discussing 
the Birth Control subject in its various and manifold aspects. 
The one issue upon which there seems to be most uncer- 



BIRTH CONTROL 171 

tainty and disagreement exists in the moral side of the subject 
of Birth Control. It seemed only natural for us to call to- 
gether scientists, educators, members of the medical profession 
and the theologians of all denominations to ask their opinion 
upon this uncertain and important phase of the controversy. 
Letters were sent to the most eminent men and women in the 
world. We asked in this letter, the following questions: — 

1. Is over-population a menace to the peace of the world? 

2. Would the legal dissemination of scientific Birth Control 
information through the medium of clinics by the medi- 
cal profession be the most logical method of checking 
the problem of over-population? 

3. Would knowledge of Birth Control change the moral 
attitude of men and women toward the marriage bond 
or lower the moral standards of the youth of the 
country? 

4. Do you believe that knowledge which enables parents to 
limit the families will make for human happiness, and 
raise the moral, social and intellectual standards of 
population? 

We sent such a letter not only to those who, we thought, 
might agree with us, but we sent it also to our known op- 
ponents. Most of these people answered. Every one who 
answered did so with sincerity and courtesy, with the excep- 
tion of one group whose reply to this important question as 
demonstrated at the Town Hall last Sunday evening was a 
disgrace to liberty-loving people, and to all traditions we hold 
dear in the United States. I believed that the discussion of 
the moral issue was one which did not solely belong to theolo- 
gians and to scientists, but belonged to the people. And be- 
cause I believed that the people of this country may and can 
discuss this subject with dignity and with intelligence I desired 
to bring them together, and to discuss it in the open. 

When one speaks of morals, one refers to human conduct. 
This implies action of many kinds, which in turn depends 
upon the mind and the brain. So that in speaking of 
morals one must remember that there is a direct connection 



172 PUBLIC MEETING 

between morality and brain development. Conduct is said 
to be action in pursuit of ends, and if this is so, then we must 
hold that irresponsibility and recklessness in our action is 
immoral, while responsibility and forethought put into action 
for the benefit of the individual and the race becomes in the 
highest sense the finest kind of morality. 

We know that every advance that woman has made in the 
last half century has been made with opposition, all of which 
has been based upon the grounds of immorality. When women 
fought for higher education, it was said that this would cause 
her to become immoral and she would lose her place in the 
sanctity of the home. When women asked for the franchise 
it was said that this would lower her standard of morals, that 
it was not fit that she should meet with and mix with the 
members of the opposite sex, but we notice that there was 
no objection to her meeting with the same members of the 
opposite sex when she went to church. The church has ever 
apposed the progress of woman on the ground that her free- 
dom would lead to immorality. We ask the church to have 
more confidence in women. We ask the opponents of this 
movement to reverse the methods of the church, which aims to 
keep women moral by keeping them in fear and in ignorance, 
and to inculcate into them a higher and truer morality based 
upon knowledge. And ours is the morality of knowledge. 
If we cannot trust woman with the knowledge of her own 
body, then I claim that two thousand years of Christian teach- 
ing has proved to be a failure. 

We stand on the principle that Birth Control should 
be available to every adult man and woman. We believe 
that every adult man and woman should be taught the respon- 
sibility and the right use of knowledge. We claim that woman 
should have the right over her own body and to say if she 
shall or if she shall not be a mother, as she sees fit. We 
further claim that the first right of a child is to be desired. 
While the second right is that it should be conceived in love, 
and the third, that it should have a heritage of sound health. 



^1 



BIRTH CONTROL 173 

Upon these principles the Birth Control movement in Amer- 
ica stands. 

When it comes to discussing the methods of Birth Control, 
that is far more difficult. There are laws in this country which 
forbid the imparting of practical information to the mothers 
of the land. We claim that every mother in this country, either 
sick or well, has the right to the best, the safest, the most 
scientific information. This information should be dissemin- 
ated directly to the mothers through clinics by members of the 
medical profession, registered nurses and registered midwives. 

Our first step is to have the backing of the medical profes- 
sion so that our laws may be changed, so that motherhood may 
be the function of dignity and choice, rather than one of ig- 
norance and chance. Conscious control of offspring is now 
becoming the ideal and the custom in all civilized countries. 

Those who oppose it claim that, however desirable it may be 
on economic or social grounds, it may be abused and the 
morals of the youth of the country may be lowered. Such 
people should be reminded that there are two points to be con- 
sidered. First, that such control is the inevitable advance in 
civiliiiation. Every civilization involves an increasing fore- 
thought for others, even for those yet unborn. The reckless 
abandonment of the impulse of the moment with the careless re- 
gard for the consequences, is not morality. The selfish gratifica- 
tion of temporary desire at the expense of suffering to lives that 
will come may seem very beautiful to some, but it is not our 
conception of civilization, nor is it our concept of morality. 

In the second place, it is not only inevitable, but it is 
right to control the size of the family, for by this control 
and adjustment we can raise the level and the standards of the 
human race. While Nature's way of reducing her numbers 
has been by disease, famine and war, primitive man has 
achieved the same results by infanticide, exposure of infants, 
the abandonment of children, and by abortion. But such 
ways of controlling population are no longer possible for us. 
We have attained high standards of life, and along the lines of 
science must we conduct such control. We must begin farther 



^ 



174 PUBLIC MEETING 

back and control the beginnings of life. We must control 
conception. This is a better method, it is a more civilized 
method, for it involves not only greater forethought for others, 
but finally a higher sanction for the value of life itself. 

Society is divided into three groups. Those intelligent and 
wealthy members of the upper classes who have obtained 
knowledge of Birth Control and exercise it in regulating the 
size of their families. They have already benefited by this 
knowledge, and are today considered the most respectable and 
moral members of the community. They have only children 
whom they desire, and all society points to them as types that 
should perpetuate their kind. The second group is equally in- 
telligent and responsible. They desire to control the size of 
their families, but are unable to obtain knowledge or to put 
such available knowledge into practice. 

The third are those irresponsible and reckless ones having 
little regard for the consequence of their acts, or whose religi- 
ous scruples prevent their exercising control over their num- 
bers. Many of this group are diseased, feeble-minded, and 
are of the pauper element dependent entirely upon the normal 
and fit members of society for their support. There is no 
doubt in the minds of all thinking people that the procreation 
of this group should be stopped. For if they are not able to 
support and care for themselves, they should certainly not be 
allowed to bring offspring into this world for others to look 
after. We do not believe that filling the earth with misery, 
poverty and disease is moral. And it is our desire and inten- 
tion to carry on our crusade until the perpetuation of such 
conditions has ceased. 

We desire to stop at its source the disease, poverty and 
feeble-mindeness and insanity which exist today, for these 
lower the standards of civilization and make for race deteriora- 
tion. We know that the masses of people are growing wiser 
and are using their own minds to decide their individual con- 
duct. The more people of this kind we have, the less im- 
morality shall exist. For the more responsible people grow, 
the higher do they and shall they attain real morality. 



BIRTH CONTROL: IS IT MORAL? 
A SYMPOSIUM OF REPRESENTATIVE OPINION 

Letters in ansiver to Questiomiaire sent preliminary 
to the Conference. 

TN ORDER to determine exactly the status of true public 
opinion concerning the morality of Birth Control as a 
practice and a program, and in order that every shade of 
thought pro and contra might be represented at the mass- 
meeting that was planned to conclude the First American Birth 
Control Conference, the following letter was sent to represent- 
ative leaders of thought and opinion: 

1. Is' not over- population a menace to the peace of the world? 

2. Would not the legal dissemination of scientific Birth Con- 
trol information through the medium of clinics by the 
medical profession be the most logical method of checking 
the problem of over- population? 

3. Would knowledge of Birth Control change the moral atti- 
tude of men and women toward the marriage bond, or lower 
the moral standards of the youth of the country? 

4. Do you believe that knowledge which enables parents to 
limit their families will make for human happiness and 
raise the moral, social and intellectual standards of the 
population? 

As a vital part of the constructive effort for future work, it 
seemed that an open discussion on this subject by men and 
women of international importance would help to guide the 
American people to a just decision. 

I would greatly appreciate an expressed opinion, if you have 
no objections, to be read at the opening meeting, knowing the 
weight it would have with the intelligent people of this coun- 
try. I have already received replies from Edward Carpenter, 
Havelock Ellis, Dean Inge, Dean of St. PauVs Cathedral, and 
the Bishop of London. 

175 



176 IS BIRTH CONTROL MORAL? 

May I hope you will seriously consider the importance of this 
and allow me to express in advance my gratitude for a brief 
letter covering, these points. 

Edward Carpenter 

English Writer, Educationalist, Thinker and Reformer 
T FEEL no doubt that the Birth Control movement is one 
of the most important of the present day. If Humanity is 
ever to rise out of the swamp of unlimited race-propagation 
in which it wallows at present, it must be by deliberate control 
of its powers of breeding. This control may reasonably be 
eflfected in two ways: (1) by wise abstinence and choice of 
times and seasons for intercourse, or (2) by artificial (but 
sanitary) devices to prevent conception. 

It may fairly be said that either of these methods is better 
than that of leaving the question of population to chance and 
the arbitrary decrees of lust. To interfere, even in an artificial 
way, with an age-long animal habit, is surely less harmful 
and immoral than to produce unwanted children, destined in 
most cases to poverty and neglect. 

But granted so much as that, there still remain certain ques- 
tions, indicated in your circular as likely to be discussed in the 
New York Conference of November 11, 12 and 13, and which 
I may for a moment consider here: 

(1) Does the spread of Birth Control involve a loss to the 
youth of the country of a valuable safeguard? It is clear, I 
think that Birth Control methods, by guarding against the 
arrival of unwanted children, may and will in some degree 
diminish the sense of responsibility attaching to sexual inter- 
course. At the same time it should be said that either of the 
above methods brings in and encourages forethought, which is 
better than a mere casual subjection to chance; and by the first 
method, the sense of responsibility is decidedly increased. 

(2) Would the knowledge of the methods of Birth Control 
lead to the reign of promiscuity? Personally, I do not think 
that promiscuity would by any means necessarily follow. At 
the same time, I think that a certain increase of latitude in 



BIRTH CONTROL 177 

sex-relations would be likely to follow — but this on the whole 
(and in view of the evils and falsity of the present system), 
I regard as not such a very great evil, perhaps in some respects 
a gain, rather than a loss. 

(3) Would it encourage the husband to impose himself on 
the wife? For answer to this, we have to look to the growing 
power of woman which necessarily will come, and is coming 
with Birth Control. Under the new order of things, it will 
daily become more unusual and more inadmissable for the 
man to impose himself on the woman; and Woman will there- 
fore enter into a state of freedom and self-determination 
hitherto unknown to and unexperienced by her sex. 

Havelock Ellis 

Author, Psychologist and Sexologist 
TT SEEMS to me that Birth Control is now itself becoming 

a part of our morality, an element in our moral ideal, 
capable, as has been well said, "of being found with us at each 
moment of our moral life, concentrated and fully felt in every 
beat and rhythm of desire and action." 

It is, therefore, idle to discuss whether or not it sometimes 
produces minor evils. No doubt it does. The moral ideal 
always does. Every line of moral action sometimes produces 
minor evils. It would be unreasonable to expect that Birth 
Control should be an exception to this universal rule. No 
one can look at the matter in a calm, broad and unprejudiced 
manner, and fail to see that the reckless disregard of Birth 
Control produces evils that are vastly greater than those pro- 
duced by its observnce. 

Only those persons who hold we should always strain at 
gnats but try to swallow camels, can venture to maintain that 
Birth Control is immoral. 

Very Rev. W. R. Inge 

Dean of St. Paul's Cathedral, London 
'VT'OU are kind enough to ask me to send a message in 
view of the approaching Birth Control Conference in New 
York. 



178 IS BIRTH CONTROL MORAL? 

There can be no doubt that if the world is to be saved from 
devastating wars and revolutions, with their accompaniments 
of pestilence and famine, the natural increase of population 
must be held in check by prudential restrictions. The old 
countries are for the most part fully peopled, and any discov- 
eries which may in the future increase food-production, ought 
to be applied to raising the standard of living, not to aug- 
menting the population. 

Already far too large a part of the population lives in large 
industrial centres, under conditions which are neither natural 
nor wholesome, and these centres are everywhere foci of anti- 
social and destructive propaganda. 

Emigration is only a palliative, and the new countries will 
not in the future be willing to admit the overflow of the teem- 
ing population of the old world. 

The tendency is at present for the better stocks to restrict 
their numbers, while the half-civilized proletariat, especially 
in countries like Russia and Ireland, multiply unrestrained. 
The evil effects of this tendency are nowhere more manifest 
than in the New England states, formerly the home of a singu- 
larly fine and virile stock. 

America and Europe are both threatened with progressive 
barbarisation. 

It is useless to preach either celibacy or abstinence in mar- 
riage. These counsels will never be acted on by those whose 
fecundity it is desired to restrain. 

The only remedy is to legalize and popularize those methods 
of control which are medically unobjectionable, and which do 
not involve the destruction of life which has begun to exist. 

Experience shov/s that abortion is rife precisely in those 
countries where the prevention is condemned by law or public 
opinion. 

At the same time we have to face the fact that we are threat- 
ened with a great outbreak of sexual license, and that acquain- 
tance with means of preventing conception has already in- 
creased these irregularities, and is likely to increase them still 
more in the future. Those who accept the Christian law of 



BIRTH CONTROL 179 

purity must watch with grave anxiety the progress of doctrines 
which cut at the root of morality, as they understand it. 

The advocacy of Birth Control, which I consider to be 
absolutely necessary, must go hand in hand with increased 
insistence on the sanctity of the marriage-vow, and on the 
obligation of continence which Christianity imposes on all un- 
married persons. 

My hope is that the new knowledge may encourage early 
marriages, and so diminish the temptation to form irregular 
connections. 

Samuel Hopkins Adams 

Author, Ensenore, N. Y. 
r\VER-POPULATION is undoubtedly a menace to world 
^^^ peace. 

2. Some systematized method under scientific direction, 
probably medical, of disseminating Birth Control information 
would be the logical agency for checking over-population. 

3. Number three embodies two separate questions. As to 
the first part, I doubt whether Birth Control knowledge would 
fundamentally change the attitude of men and women toward 
the marriage bond. As to the second, I am definitely of the 
opinion that such knowledge, if it becomes common property, 
will "lower the moral standards of the youth of the country," 
at least until such time as society can adjust itself to the new 
status and perhaps find other safeguards to substitute for the 
"danger signal" of "results." To assume the contrary is to 
deny a salient fact of human nature. Say to headlong youth, 
"You may now adventure in safety," and there will inevitably 
be a response in the direction of moral laxity. Enthusiasm 
for the cause should not blind us to this, its chief drawback. 
That compensating advantages would more than offset it 
seems to me clearly true. But the fact remains that we must 
be prepared to accept a measure of harm for the sake of the 
ultimate and greater measure of good. 

To the question of whether knowledge which enables parents 
to limit their families will make for human happiness and 



180 IS BIRTH CONTROL MORAL? 

raise the general standards of the race, I answer with all pos- 
sible emphasis, "Yes." 

Katharine Anthony 

Author 
TT SEEMS very appropriate that the first American Birth 
Control Conference should begin on the same day as the 
first International Disarmament Conference. For it is un- 
doubtedly true that over-population contributes to war as 
directly as competition in armament. Probably the reduction 
of armament means even less for the peace of the world than 
reduction of surplus population. A world which really wants 
peace will take as much interest in the control of the birth-rate 
as in the reduction of armament. 

That poverty as well as war thrives on over-population is 
hardly disputed in academic circles. Economists from John 
Stuart Mill to the latest experts on American income statistics 
have repeatedly told us that. One needs to be indifferent to 
the plainest lessons of history and economics in order to con- 
demn Birth Control or ignore the question. 

If family limitation, then, helps to prevent war and poverty, 
it can scarcely be tabooed on grounds of immorality. For the 
best that has ever been said on behalf of war and poverty is 
that they are necessary evils, not that they are moral assets. 

From the point of view of society, Birth Control to this 
extent has its moral uses. And from the point of view of the 
individual, a moral attitude which is sustained by ignorance 
and fear is a feeble thing to depend upon. Young people have 
a right to expect a better ethical nourishment from those who 
set up moral standards for their education. 

Prof. E. C. Barker 

The University of Texas, School of History 
I. Over-population, undoubtedly, produces poverty and 
distress, which begets discontent, turbulence violence. This, 
of course, is a menace to the "peace of the world" in the sense 



BIRTH CONTROL 181 

of tranquil content. I am doubtful whether it is a menace in 
the sense of bringing on national wars. 

2. Yes. 

3. (a) I don't think such knowledge would affect attitude 
toward marriage. 

(6) I am inclined to think it might lower moral standards, 
but the modern youth is a strange animal, and I'm not at all 
sure the effect would be harmful. 



Bernard I. Bell 

President, St. Stephens College, Annandale-on-Hudson 
r\VER-POPULATION is indeed a menace to the peace of 
^"^ the world. It is only fair to say, however, that Oriental 
over-population constitutes the major part of this danger. The 
limitation of population in America and Europe would mean 
almost certainly a considerable advantage to the yellow races 
in their overrunning of the world. This phase of the subject 
needs careful thought. It may be that Occidental brains could 
overcome and control Oriental hordes of people. I am not 
sure. 

2. I personally believe in the legal dissemination of sci- 
entific Birth Control information through the medium of clinics 
by the medical profession. 

3. I do not believe that men and women are kept moral 
through fear and therefore I am under the impression that the 
giving of information mentioned above would not in any sense 
lower the standards of the youth of this country. Nor do I 
believe that it would have any bad effect upon the attitude of 
men and women toward marriage and divorce. 

4. I do believe that small families make for human happi- 
ness. Too many children reduce the standard of living below 
that where social and intellectual interests can properly be 
cared for. On the other hand, childlessness makes for an ab- 
normal and unintelligent attitude toward life and for warped 
and morbid art. 



182 IS BIRTH CONTROL MORAL? 

Edwin W. Bowen 

Randolph-Macon College 

1. I think over-population is a menace to the peace of the 
world. 

2. I believe your suggestion as to the legal dissemination 
of scientific Birth Control information through the medium 
of clinics by the medical profession to be the most logical 
method of attaining the desired. 

3. I am unprepared to answer this question as I have not 
formed an opinion on the points involved. 

4. I am inclined to answer this question in the affirmative; 
viz., that knowledge which enables parents to limit their 
families will make for human happiness and raise the moral 
standard, as well as the social and intellectual standards of 
the population. 

Frederick A. Bushee, Ph.D. 

University of Colorado^ Boulder, Colo. 

IF ULTIMATE rather than immediate influences are consid- 
sidered, I believe that over-population should be ranked 
as the chief cause of war. 

2. It would be one important method of controlling popula- 
tion; but it would not by itself suffice for the ends sought by 
the Eugenists. Other methods would have to be used to con- 
trol the reproduction of undesirables. 

3. In some cases where moral standards are based on fear, 
it might lower those standards ; but I think the possible danger 
from this source is not comparable to the benefits to be derived 
from increased knowledge. I do not believe that the attitude 
towards marriage would be much affected. 

4. My opinion is that it would not, and the evidence from 
Holland seems to confirm this opinion. 

Pierce Butler 

H. Sophie Newcomb Memorial College, Tulane University of Louisiana 

/~\VER-POPULATION is quite obviously a relative term; 

in itself, it is not a menace to the peace of the world. 

The real problem is to continue and to perfect man's command 



BIRTH CONTROL 183 

of the resources enabling life upon the earth. The law of 
life, for the race as well as for the individual, is life, more life, 
not suicide. 

2. Dissemination of Birth Control information would un- 
questionably be the most logical means of checking the growth 
of population. But the danger of the logical machinery is 
that it is machinery, and that it operates, necessarily, on data 
or materials supplied by admittedly imperfect human knowl- 
edge. In other words, the premises may be, perhaps must be 
unsound; yet the machine once started goes ahead. 

3. The soundest and most persistent race known to history, 
the Hebrew, was built upon a code largely of social laws 
regulating the sexual instincts. And the very names applied 
in science to certain sexual offenses come from Hebrew his- 
tory — all condemning evasions or perversions of the law of 
procreation. Self-control, cultivation of the will, which is 
given to man that he may avoid all acts likely to be harmful 
to him, is what must be taught as the basis of sexual or any 
other morality. Responsibility for one's actions is a basic 
condition of society. The dissemination of any information 
that claims to relieve the individual of his responsibility is 
bound to lower the standards of men and women. 

4. A sufficient answer to this question is implied in the 
answer to the third query. 

Perhaps I might be permitted to add, in view of my ref- 
erence to the Jews, that I am not a Jew, that I am quite aware 
of the many peculiarities of the Jew which are distasteful to 
me, that I am quite aware of what may be said in regard to 
the Hebrew codes and the oriental society of a primitive age, 
and that I am by no means disposed to make a fetish of the 
Bible. "Morality" is simply an effort to help adjust man to 
the complex relations with his environment — material, social, 
spiritual. And, in essentials, there is no "new" morality. 

W. B. Cannon 

Department of Physiology, Harvard Medical School 
T^O THE first, second and fourth questions put to me in 
your letter of October 20th, I should give an affirmative 



184 IS BIRTH CONTROL MORAL? 

answer. With reference to the third question, it seems to me 
that we should have to rely on the evidence of experience. It 
is my belief that such knowledge would not alter moral stand- 
ards, but I should prefer to have investigated the effects in 
countries where such knowledge is widely diffused. 

Dr. Will Durant 

Director, Labor Temple School 
'X/'ES, I believe that over-population is the chief cause of 
war, and that "the legal dissemination of scientific 
Birth Control knowledge by the medical profession through 
the medium of clinics" is "the most logical method of check- 
ing the problem of over-population." 

To prevent such information from facilitating extra-marital 
relations I would limit it to legally married men and women; 
to these I think such knowledge should be not only permitted 
but offered. I am sure that Birth Control would raise social 
and intellectual standards, if confined to the married. To off- 
set the so-called "yellow peril," it would only be necessary to 
raise the quality of our own people by better education, and 
to spread Birth Control knowledge abroad so as to decrease 
the quantity of people whose unchecked reproduction threatens 
international peace. 

All success to the Birth Control Conference; and congra- 
tulations on your many years of courageous and now success- 
ful effort to arouse America to the problem and the solution. 

Professor Warner Fite 

Department of Philosophy, Princeton 
TT GIVES me great pleasure to reply to the four questions 
proposed in your letter of October 22nd, as follows: 

1. I believe that over-population is the most serious menace 
to the peace of the world. It furnishes not merely one motive 
for war, but the motive which, in the end, underlies and sus- 
tains all other motives, and the only one which makes war 
inevitable. 

2. I believe that Birth Control based upon scientific inves- 



BIRTH CONTROL 185 

ligation and the dissemination of scientific information, is the 
only logical and, I should add, the only moral and human 
method of controlling population. The only other method I 
can think of is to allow war and starvation to produce their 
natural results. 

3. I believe that common knowledge of easy and certain 
methods of Birth Control could not fail to work some change 
in the moral attitude of men and women towards the marriage- 
bond and some change in the moral ideas of the youth — just 
because the calculation of consequences and the fear of con- 
sequences form so large and so corrupting an ingredient in the 
composition of present sex-morality. With the fear of con- 
sequences removed, there would undoubtedly be some increase 
in the number of illicit sex-relationships. But I cannot see that 
this would be a moral loss, or that there is a moral advantage 
in preserving a spurious chastity. On the other hand, there 
would be a corresponding — perhaps more than corresponding 
— increase in the number of early marriages and in the mar- 
riages now forbidden by economic conditions. This would be 
a great and important gain in the direction of wholesomeness 
of life both personal and social. And in the end I think that 
the moral effect of Birth Control as an established fact would 
be to sift out and make clear the motives of personal devotion 
and loyalty which constitute the true marriage-bond; to em- 
phasize the sanctity of these motives; and thus to make the 
marriage bond stand for a higher conception of life than it 
does at present. 

4. To me the importance of Birth Control as a condition of 
any advance in cultural {i.e., moral, social, intellectual) life 
is simply obvious. Every such advance rests upon the possi- 
bility of transforming some part of life from a necessity of 
nature into a matter of personal choice. It does not follow 
from this that the choice will be narrow and ignoble. I have 
no criticism to pass upon those who are voluntarily childless — 
that is genuinely their own affair, — but I think that few parents 
really envy them. Yet to make the coming of children worth 
while, for them, for us, for society generally, we must be able to 



186 IS BIRTH CONTROL MORAL? 

control their number. And to say that modern life makes 
children a burden is only to say that today each child is an 
object of responsible concern and solicitude as he never was 
before. It matters not what view we take, personal, family or 
social. If human life is to be more than a feeding of mouths 
we must control the number of mouths to be fed; if population 
is to do more than press upon subsistence, we must control the 
population. 

These replies are at your service, to read at the open meet- 
ing or not, as you judge worth while. 

Franklin H. Giddings 

Faculty of Political Science, Columbia University, New York 
ll/TY ANSWERS to the questions propounded in your letter 
of October 18th, are as follows: 
1 and 2. Yes, with a word of explanation. 

3. First half of the question, I don't know. Second half 
of the question, emphatically no. Every vicious use that could 
be made of such knowledge is made already. It is only the 
wise use of the knowledge that we lack. 

4. Yes. 

The word of comment on 1 and 2, and it applies in a 
measure to 4, is that it is more important to change the quality 
than limit the quantity of world population. I am strongly 
in favor of limitation of the families of low-grade intelligence 
and vitality, and quite as strongly in favor of increasing the 
birth-rate of the families that are energetic, intelligent and of 
sound character. You see I am above all things a eugenist. 

Dr. Ernest H. Gruening 

An Editor of The Nation, New York 
/^NE. Is not over-population a menace to the peace of the 
^"^ world? 

(A.) A great menace. There are altogether too many people 
in the world. Quality, not quantity, should be the desidera- 
tum. If men and women are really superior to beasts, it is in 
their ability not to breed like rabbits or to spawn like jelly 



BIRTH CONTROL 187 

fish and turn their offspring into the ruthless jungle existence 
of tooth and claw, but to bring wanted, carefully nurtured, 
love-children into the world endowed with all the strength and 
fineness and potentiality for a happy existence which the plan- 
ning and devotion of thinking beings can encompass. The 
over-population of the world has already borne the bitter 
fruit of war. Germany's congested multitudes were taught to 
believe that they were surrounded by enemies, that the open 
spaces of the world had been preempted, and that Germany 
had to expand forcibly in order not to perish. However false 
this assumption, the fact remains that the Germans believed 
it, and it was a potent factor in producing the catastrophe of 
1914-1918. Japan's problems are similar — her overcrowding 
and inability to overflow into other lands underlies the present 
tense Far Eastern situation. Over-population is responsible 
for the fierce economic struggle all over the world. The 
changed conditions in the United States in the last 20 years, 
the repressions of the present day, the development of class 
consciousness and the intensification of the industrial conflict 
are merely manifestations of the patent fact that our country 
has at last filled up and has become over-populated. Un- 
employment, an acute symptom of this condition, means noth- 
ing less from an economic standpoint than that there are too 
many people for our present system to support. A still graver 
symptom are the famines which regularly afflict sections of 
the earth, notably China, which we then belatedly and in- 
effectively try to relieve by feeble palliative measures. 

Two. Would not the legal dissemination of scientific Birth 
Control information through the medium of clinics by the 
medical profession be the most logical method of checking the 
problem of over-population? 

(A.) It would. It is essentially the duty of the medical 
profession to accept full responsibility for the therapeutic 
phases of this problem. The new spirit in medicine demands 
that diseases be prevented wherever possible. The old adage is 
particularly applicable to matters of health that "an ounce 
of prevention is worth a pound of cure." 



188 IS BIRTH CONTROL MORAL? 

Three. Would knowledge of Birth Control change the 
moral attitude of men and women toward the marriage bond or 
lower the moral standards of the youth of the country? 

(A.) Neither. On the contrary insofar as it would tend 
to eliminate for all time the crime of abortion, its effect would 
be distinctly moral. 

Fouk. Do you believe that knowledge which enables par- 
ents to limit their families will make for human happiness 
and raise the moral, social and intellectual standards of the 
population? 

(A.) I believe that no single reform capable of such im- 
mediate and wide-spread application would so greatly add to 
the happiness of the human race. There are no panaceas, but 
Birth Control properly established would go further to elim- 
inate poverty, sickness, insanity, crime, with all that these 
scourges imply, than any other remedy proposed. 

Cosmo Hamilton 

Author, New York 
/^VER-POPULATION is a menace not only to the peace of 
^■^^ the world but to the sane conduct of peace, because the 
health of nations and their standard of intelligence are forever 
at the mercy of accidental multitudes born into a life in which 
they are hopelessly superfluous. The question of Birth Control 
and its legal and scientific information by doctors is, more 
than ever now, as vitally necessary to the future well-being of 
the human family as disarmament itself. As every addition to 
true knowledge is an addition to human power, it follows that 
the moral standard of youth must be raised and the sense of 
responsibility strengthened and inspired by the proper teach- 
ing of the essential and urgent truth. 

John Haynes Holmes 

Community Church, New York City 
"V^OUR first two questions bring up the issue of over- 
population. May I say that I have never been able to feel 
that the alleged menace of over-population offered the best 



BIRTH CONTROL 189 

approach to the question of Birth Control. There was a time 
when over-population constituted a real menace, witness for 
example, the life of Francis Place, who was so greatly con- 
cerned with this matter. In our time, however, it seems to me 
that the menace has largely disappeared, at least from our 
Western world. Perhaps you know Prof. Patten's book "The 
New Basis of Civilization," the thesis of which is that our 
civilization in the last half of the 19th century definitely passed 
from what he calls the basis of deficit to the basis of surplus. 
In other words, we have in our hands today the means of pro- 
viding for a much larger population than is now living on this 
planet. The argument in this book impressed me as being 
convincing. Furthermore, my study of war as a modern 
phenomenon has not brought the over-population issue into 
much prominence. If we could rid our world of economic 
imperialism, secret diplomacy, competitive armaments and the 
whole philosophy and structure of nationalism, we could get 
rid of war even with a much larger population in Europe and 
America than actually exists today. I say all this subject to cor- 
rection, for I have given no prolonged study to the problem 
of population. I feel fairly confident, however, that the real 
approach to the Birth Control problem is along other and 
much more effective lines. 

Fannie Hurst 

Writer of Stories and Scenarios, New York 
13EPLYING to your questionnaire: 

1. Yes, I do consider over-population a menace to the 
peace of the world. War can be said, fundamentally, to be 
the result of overcrowding. 

2. Yes, I emphatically do think that the legal dissemina- 
tion of scientific Birth Control information through the medium 
of clinics by the medical profession, would be the most logical 
means of checking the problem of over-population. Much 
damage is done by careless, ignorant or illegal methods of 
preventing conception; irreparable damage is done by in- 
voluntary motherhood, so from both sides of the question. 



190 IS BIRTH CONTROL MORAL? 

scientific Birth Control information, disseminated through 
clinics would be of greatest social and pathological value. 

3. Yes, I believe that knowledge which enables the parents 
to limit their offspring will make for human happiness and 
raise the moral, social and intellectual standards of the popu- 
lation. Ignorance of this fundamental knowledge is responsi- 
ble for much of the human misery in the world. 

Mary Johnston 

Novelist 
IV/TY FEELING is that the lasting solution lies in an increas- 
ing continence and a sublimation, all along the line, of 
the sex nature. And I should like to see arise a movement 
which should directly inculcate this. 

But it is likewise my opinion, that pending this slow inner 
and spontaneous change, there should be available in this and 
all countries correct instruction in Birth Control. 

David Starr Jordan 

Chancellor, Leland Stanford University 
TN ANSWER to your questions, let me say I do not regard 
the possible over-population of the world as a pressing 
question now or for centuries to come. The real problem is 
the over-congestion of certain districts, results of weakness, 
ignorance, indolence and oppression. 

The cost of a few dreadnoughts applied to sanitation of the 
tropics, to education, industrial and other, and to development 
of new industries would go far towards relieving this. There 
are even in Japan and Korea, millions of acres of unoccupied 
land, fitted for rye, oats, hay and grazing, but which cannot 
be utilized without capital and without governmental efforts 
towards establishing mailkets for cheese and butter, now 
scarcely used in the Far East, where the people subsist mainly 
on rice, an unwholesome food when unrelieved. In Japan, 
only the homeless poor will emigrate, those who have even 
two acres of good land preferring to stay at home, "where 
our customs fit us like a garment." The "menace" in the Far 



BIRTH CONTROL 191 

East consists not in over-population, but in military coercion 
with over -population as an excuse. Before the war "over- 
populated Germany" imported each year from Italy and Po- 
land upwards of a million unskilled laborers to do her heavy 
work. 

Birth Control will not relieve congested districts, for at 
present, at least, it is likely to reach only those classes which, 
in general, do not provide for their own continuance. In this 
connection, however, it must be remembered, that the "upper 
classes" socially or financially, do not necessarily represent 
the best race-material, though the slums, as a whole, with 
individual exceptions, comprise much of the worst. 

I do not approve of the paternalism of the laws prevent- 
ing "dissemination of knowledge of Birth Control." It is 
probable, however, that lifting the ban would let loose a flood 
of quack devices and remedies. 

I do not believe that genuine knowledge of any sort would 
lower moral standards of any one who had any. Virtue and 
vice have deep roots. 

I am not convinced that "knowledge which enables parents 
to limit their families would appreciably make for human 
happiness and raise the moral, social and intellectual stand- 
ards of the population." In this I may be mistaken, but to 
the present, I find affirmative statements unconvincing. 

Those classes who suffer most from congestion are the ones 
such information and arguments do not reach. It is the weak- 
ness of the weak, not the strength of the strong, which lies at 
the root of oppression. 

Setting aside the sterility which springs from vice, the re- 
duction in the birth-rate is a result, on the whole beneficient, 
of the emancipation of woman. A large factor in the change 
has been the acquisition of separate apartments for the mother 
of the family. 

Judge Ben. B. Lindsey 

Juvenile Court, Denver, Colo. 
THIRST: I should say that over-population, as the world is 
now organized and conducted under our present system 



192 IS BIRTH CONTROL MORAL? 

of civilization, with all of its stupidities, would certainly be a 
menace to the peace of the world. 

Second: Legal dissemination of scientific Birth Control 
information through the medium of clinics by the medical pro- 
fession, if not the most logical, would certainly be a very 
logical method of checking the problem of over-population. 

Third: There is nothing in this world that I am more con- 
vinced of than that knowledge of Birth Control would posi- 
tively not change the moral attitude of men and women towards 
the marriage bond, or lower the moral standards of the youth 
of the country. On the contrary, I am positive it would im- 
prove and increase both. Did time permit, from my expe- 
rience here, I think I could give many reasons for this belief. 

Fourth: How any one could doubt that knowledge which 
enables parents to limit their families could fail to make for 
human happiness and raise the moral, social and intellectual 
standards of the population, is more than I can understand. 
Of course I believe that such knowledge would do all of these 
things and to my mind it is little short of crime itself that such 
knowledge is being withheld. 

May I say in conclusion that if we squarely faced this issue 
and had some rules and regulations through which scientific 
Birth Control information could be disseminated through the 
proper mediums, it would do much to end the promiscuous and 
oftimes misleading information which is positively being cir- 
culated quite generally now with reference to Birth Control, — 
the truth is that no power on earth is going to prevent people 
from getting knowledge of Birth Control, no matter what one's 
views may be, but because of a sort of "dog-in-the-manger" 
attitude of those who oppose Birth Control and because of a 
very well meaning but I think mistaken attitude of some of our 
moralists, birth control information — which they are not stop- 
ping — is prohibited or adulterated with so much misinfor- 
mation that we are prevented from getting real, genuine good, 
such as would come from a proper dissemination. 



BIRTH CONTROL 193 

Owen R. Love joy 

General Secretary, National Child Labor Committee 
T DO not regard over-population a menace to the peace of 
the world. On the contrary, I believe the world capable of 
sustaining a population ten-fold or perhaps a hundred-fold 
greater than the present. The peace of the world is menaced 
rather by the application of the philosophy of imperialism 
backed by the military profession. 

2. I am not interested in the legal dissemination of sci- 
entific Birth Control information for the purpose of checking 
the problem of over-population, for the reason that I do not 
regard over-population as a problem. Any menace that exists 
in the matter of population itself is due to the quality produced, 
rather than to the quantity. 

3. Properly taught, a knowledge of Birth Control should 
raise rather than lower moral standards and strengthen the 
marriage bond. 

4. Yes. Man is supposed to be an intelligent animal, and 
in the most sacred of all relations in life should be guided by 
knowledge. The danger is that knowledge "which enables 
parents to limit their families" will reach only those who are 
already conversant with family obligations, while the ignorant, 
vicious and physically unfit will not be retarded by any con- 
siderations of social well-being, and the reverse of the end you 
seek to attain will result. 

Finally let me emphasize that any argument for Birth Control 
based on fear of over-population or on the fear that individual 
families will be financially unable to support their offspring 
is vicious because it starts from a false premise. The world is 
big enough and rich enough to furnish a foothold for all the 
children that can be born under decent health conditions. 

Eden Paul, M.D., and Cedar Paul 

English Authors and Translators 
nnO BE quite frank — we regard Birth Control as (at the 
moment) a side issue. Like alcoholism, venereal disease, 
and half-a-dozen other matters we might name, it is of great 



194 IS BIRTH CONTROL MORAL? 

importance to the welfare and happiness of the human race. 
But unless another, more urgent, and more vital problem is 
rightly solved, in the near future, we do not think that what 
Winwood Reade termed the Martyrdom of Man will end ex- 
cept by man's extinction, or that mankind in the future will 
have any happiness or welfare worth considering. We allude 
to this other problem without particularising, only to explain 
why (while admiring your single-minded devotion to the cause 
you have at heart) we are not ourselves at present giving much 
time to Birth Control propaganda. 

As to the special points on which you ask our opinion, suf- 
fice it to say that in our view anyone who is hostile to Birth 
Control on what are termed "moral" grounds is obviously 
living in the "Middle Ages" instead of in the modern world 
(we do not say "in the Dark Ages," for that period is not yet 
over for any of us — although there is a glimmer of dawn in 
the East. Except for that glimmer, we are all in the Dark 
Ages). 

When the new day dawns, much of what our contemporaries 
are accustomed to term "morality" will seem as strange to us, 
as repugnant to human sentiments as an auto-da-fe or the 
crucifixion tree of a West African monarch. 

When that day dawns, the very question "Does the spread of 
Birth Control involve the loss of a valuable safeguard (!) to 
youth?" — "Would knowledge of the methods of Birth Control 
lead to a reign of promiscuity?" — "Would it encourage the 
husband to impose himself on the wife without considerations 
for her feelings?" — will seem positively absurd. But in truth 
they are already absurd to all who know anything about sex, 
to all with any tincture of the New Psychology. 

Birth Control is an important element in "Man's Control of 
Nature?" As such it has come to stay — if in other respects 
man makes good his claim to be the Maker of Things. 



BIRTH CONTROL 195 

George Foster Peabody 

Banker, New York 

I DO not think over-population a menace to the peace of 
the world. I think a false economic system and the pre- 
valence of privileged interest under all forms of government 
so far devised the true menace. I think it will continue a 
menace if the population should be half what it is, as it was 
some hundreds of years ago. I believe, however, in demo- 
cratic-republican government with the initiative, referendum 
and recall and not at all in the principles of socialism. 

2. I think there should be a check to the over-population 
in the class of Morons, etc. I am not clear that the legal dis- 
semination of the scientific information you advocate would 
be effective in that direction. 

3. I greatly fear that the vigorous advocacy of the prin- 
ciples you stand for would injuriously affect the moral at- 
titude. 

4. I do not believe in limiting scientific knowledge and 
believe the legal prohibition of the dissemination of any well 
established scientific propositions harmful. 

You will see my objection is purely to the very great damage 
I fear it would do to the general moral attitude. I think the 
first essential is to work strongly for the single standard of 
morality and continue to denounce the prevalent acceptance 
of the double standard. That seems to me the necessary pre- 
liminary step. 

I am, of course, not only sorry but somewhat disturbed in 
my convictions by not being in step with so many of my per- 
sonal friends and associates in various movements, whom I 
so greatly admire. Nearly half of the names on your con- 
ference committee are people with whom I am in strongest 
sympathy in many directions and some are my close personal 
friends whom I profoundly admire. 

Charles Edward Pell 

Author of ''The Law of Births and Deaths." 
T AM honored by your courteous request that I should lay 
■^ my views upon the vexed questions of Birth Control be- 



196 IS BIRTH CONTROL MORAL? 

fore your forthcoming Conference. Of course you know that 
my own particular view is that the present decline in the birth- 
rate is due in the main, not to the use of contraceptives, but 
to a law of Nature the function of which is to adjust the birth- 
rate to suit approximately the needs of the race as manifested 
in the deathrate — a law the action of which can be clearly 
traced throughout human society, the animal kingdom, the 
vegetable kingdom, and even among unicellular organisms. 

Nevertheless, my ultimate ideal — an intelligently regulated 
birth-rate — is exactly the same as your own, and I have no 
prejudices as to the methods by which this result is to be ob- 
tained. I recognize that, even granting the existence of such 
a jaw as that which I have sketched out in my book: "The 
Law of Births and Deaths," there are certain circumstances 
under which the use of contraceptives is defensible and even 
desirable. No one, I suppose, advocates the use of contra- 
ceptives for their own sake; but to those who urge that their 
use is an evil, it is permissible to reply that they are obviously 
a lesser evil than the multiplication of the hopelessly unfit 
whose reproduction is under all circumstances undesirable, 
and to whom the giving of advice about moral restraint is like 
advising the Ethopian to change his skin or the leopard to 
change his spots. They are a lesser evil than the dragging 
down to poverty and misery of married couples and their chil- 
dren through the reproduction of families of a size far beyond 
their ability to support. While, as to the assertion that pro- 
miscuity of sexual intercourse is likely to result, it may be 
pointed out that the number of illegitimate children born and 
the number of abortions procured show that an absence of 
contraceptive knowledge is no guarantee of morality. 

But this question of Birth Control has two main aspects. 
There is the question of the control of births as practiced occa- 
sionally with more or less success in individual families; and 
there is the question of the control of the birth-rate as a whole. 
The latter is the really important problem; and it must be 
remembered that a merely falling birthrate is not a controlled 
birthrate. At present the better stock in all the leading coun- 



BIRTH CONTROL 197 

tries of the world is not merely reproducing least but tending 
to dwindle away, anything from a quarter to a third of them 
being childless. The old American stock is steadily dying out. 
The least efficient classes are producing the greater part of suc- 
cessive generations. Such a birthrate cannot be called regu- 
lated. Under-reproduction, with depopulation and the dying 
out of the better stock, is just as disastrous and undesirable on 
the one hand as over-production on the other. In my judg- 
ment we can only obtain an intelligently regulated birth-rate 
by a study of the biological problems involved along the lines 
laid down in my book, and by obtaining such an intimate 
knowledge of the laws governing reproduction as will enable 
us to secure fertilization at will. 

It is true that the social and economic problems also in- 
volved in the securing of a really controlled birth-rate are 
stupendous, but that is not an argument for shirking them. 
It is an argument for attacking them as promptly as possible. 
And consider the tremendous advantages which would result 
from success. Not only would the spectres of depopulation 
and over-population be banished forever, and with them much 
of the poverty and misery at present prevailing, but the ability 
to obtain the largest proportion of births from the abler sec- 
tions of the community, and the smallest proportion from the 
least fit, would open up vast possibilities of physical, moral, 
and intellectual development for the race. 

For the American people the securing of a regulated birth- 
rate offers one very special advantage. The negro problem 
and the antagonism between white and black must become 
steadily more acute with the growth in numbers of the negro 
population. The only suggestions for a solution which I have 
ever seen are that the negroes should be deported to Africa or 
segregated in an area by themselves — suggestions even the 
authors of which must feel to be impracticable. But the wave 
of sterility now sweeping over America, in common with the 
leading countries of Europe, will ultimately overtake the 
negroes. Indeed, I believe it has already affected them to a 
not inconsiderable degree. If, then, it is possible to obtain the 



198 IS BIRTH CONTROL MORAL? 

power to secure fertilization at will, it should only be neces- 
sary to obtain as many children per family as are needed for 
the maintenance of the white race while allowing the negro 
population to diminish through increasing sterility. 

There is nothing impracticable about such a course, as 
nothing in the way of coercion is involved and the onset of 
sterility is a practical certainty. If it be argued that a birth- 
rate so controlled is impossible of realization, the reply is that 
we must make it possible or see our civilization perish. We 
can conquer only by studying both sides of the question, by 
recognizing the danger of depopulation as well as over- 
population, and by studying the biological aspects of the prob- 
lem alone. Given a readiness to attack the problem with clear 
heads and open eyes, we shall probably see the impossibilities 
vanish into thin air. 

I trust that your Conference will bear steadily in mind the 
fact that a merely falling birth-rate is not a controlled birth- 
rate, and that it is the latter we require. I also trust that they 
will make a special point of searching minutely into the 
biological as well as the moral, economic, psychological and 
other sociological aspects of the question. 

In conclusion may I offer you my congratulations upon the 
magnificent courage you have shown in grappling with this 
great problem, and my best wishes for the success of the Con- 
ference. 

Dr. Mary Scharlieb 

English Surgeon 
"IVTANY thanks for your letter received this morning. 
I will do my best to briefly indicate my position with 
regard to this important subject. 

In my opinion the limitation of families is wrong and 
dangerous because it does not control or discipline sexual pas- 
sion but aims at the securing of the privileges of the married 
state while it shirks the responsibilities attached thereto. Thus 
it does away with the natural discipline of married life. 

Secondly, the artificial prevention of conception does not 
appear to me to be in the real interest of the wife. It is true 



BIRTH CONTROL 199 

that it may relieve her from the burdens of pregnancy and 
lactation and from the care that is involved in the proper 
bringing up of a large family. On the other hand the logical 
outcome of the removal of all restraint from the husband's 
desires tends to the virtual enslavement of the wife. Many 
men who have not the moral and intellectual development 
that is necessary to secure for her proper respect and consid- 
eration now refrain from making undue demands upon her 
for fear of the consequences, but when relieved from this fear 
they would recognize no limit to their desires. This most un- 
desirable condition of things is not the intention and object of 
those who advocate artificial control but it is the logical out- 
come of their propaganda. 

Thirdly, it is impossible to instruct married women in arti- 
ficial methods of preventing conception without at the same 
time instructing unmarried women and girls. In doing this 
the outside conscience is removed: fear of disgrace and of 
adverse public opinion gives place to an unhealthy confidence 
that sin may be enjoyed and no unpleasant consequences will 
result. Already promiscuous intercourse is far too frequent, 
and its results in illegitimate births and in the dissemination 
of venereal disease are greatly to be deplored. Artificial pre- 
vention of conception, although to some extent protecting the 
girl or woman against the natural consequences of her action, 
would tend to blunt her moral sense and degrade the national 
standard of purity. 

Fourthly, from the doctor's point of view the use of arti- 
ficial contraceptives is wrong, because although many of them 
do not necessarily inflict any local, mechnical, or chemical 
injury, their effect on the nervous system is certainly injurious. 
Much of the joy and spontaneity of married relationship is 
destroyed, and the woman's nervous health appears to suffer 
not only during child-bearing years but more markedly at, 
and after, the menopause. 

In addition to these reasons there are the wider considera- 
tions of national welfare, and of contravention of the Divine 
command — "Be fruitful and multiply." 



200 IS BIRTH CONTROL MORAL? 

Mary Kingsbury Simkhovitch 

Professor Social Economy, Greenwich House, New York 
T BELIEVE that doctors should be free to impart such 
information and give such advice as they regard to be of 
benefit to their patients. 

John S. Sumner 

Secretary, The New York Society for the Suppression of Vice 
/~\UR replies to the questions which you propounded fol- 
^■"^ low: 

1. Over-population is not a menace to the peace of the 
world because there is no over-population. It is true that in 
some countries the density of population exceeds that in other 
countries, and that in cities there is hurtful congestion of pop- 
ulation; but it must be remembered that prior to the World 
War, Belgium was the most densely populated country in 
Europe. It was also the most peaceful, prosperous and con- 
tented. It is not the physical fact of population but the mental 
and spiritual condition of a people which determines the ques- 
tion as to a menace to continued peace. 

2. If there were general over-population as distinguished 
from congestion of population in certain limited areas, the 
logical way to meet the condition would be to check the birth 
rate or practice euthanasia among the unfit. But we are told 
by the disciples of Birth Control in Holland, where the doctrine 
is practiced, that there is no decline in the birth rate and that 
the period of the individual life has been increased. This 
would eventually lead to increased density of population and 
therefore the doctrine of so-called Birth Control, as practiced 
in the Netherlands, could not be an effective offset to over- 
population. 

3. The knowledge and practice of Birth Control, through the 
prevention of conception, would and has changed the moral 
attitude of men and women toward the marriage bond, or pref- 
erably the marriage status. This is indicated by divorce sta- 
tistics. Consider New York City. In 1919 there were 1224 
matrimonial actions or 1224 married couples in the Courts 



BIRTH CONTROL 201 

seeking to have a complete or partial dissolution of the mar- 
riage contract. As issue of these parties there were only 399 
minor children. If each child were the issue of different par- 
ents that would still leave 825 or 67 per cent of childless mar- 
ried couples seeking to avoid a relation which was entered 
into for life. In practice so-called Birth Control means birth 
prevention and without a child, the climax of the assumption 
of the obligations of marriage, the parties to a marriage are 
inclined to regard that status with levity, to be assumed or dis- 
carded like a garment. 

The knowledge of Birth Control, which is birth prevention, 
would lower the moral standards of the youth of the coun- 
try. Anything which tends to encourage the evasion of 
obligations saps and breaks down moral fibre. The chief 
obligation of marriage is procreation. The husband and wife 
are partners in an enterprise, and the crowning glory of that 
enterprise, the true consummation of marriage, is the child. 
Unfortunately, the tendency of the day is to devote too much 
time to frivolous pleasure. This is true of all classes and ages. 
The result is an inclination to avoid what would interfere with 
self indulgence. There is no doubt that the bearing and rear- 
ing of children is such an interference. It follows that if 
knowledge for the prevention of conception is imparted to 
youth with authority and as a desirable thing endorsed by 
"nice people," that youth will eagerly accept and use that 
knowledge. At first the idea may be merely to delay pro- 
creation, but delays are dangerous and usually result in utter 
abandonment and as a result life's greatest and most soul- 
satisfying obligation, the obligation of parenthood, is entirely 
avoided. That is the story of the increasing divorce rate and 
the purposeless lives of so many. 

Character is built by assuming obligations and overcoming 
difi&culties. If obligations are evaded there is no character. 
Without character there is no moral standard. If we equip 
and encourage youth to evade life's greatest obligation, we are 
going far in the direction of no moral standards and purpose- 
less, disappointed, bitter lives. Our elders did not serve us so. 



202 IS BIRTH CONTROL MORAL? 

4. We believe that where there is the probability of 
diseased or mentally defective progeny, or where the health or 
life of the mother would be endangered by child-bearing, 
parents should be advised against further issue and should be 
informed personally by a licensed physician of any known 
harmless means toward such a result. This can be legally done 
at the present time. It requires no propaganda and no change 
in the State law. 

A correspondence course on the subject or remedies fur- 
nished by a mail order house would be neither safe nor useful. 
There is no need for a change in the Federal law. It would 
certainly result in a renewal of that situation when the mails 
were flooded with sealed packages addressed to boys and girls, 
placing temptation in their way with a promise of safety from 
unfortunate consequences, for the financial profit of vicious 
and mercenary interests. 

We favor the prevention by present legal means of the ag- 
gravation or transmittal of either physical or mental disease 
and believe that it would make for human happiness and would 
raise the social and intellectual average of the community and 
probably also the verge of moral conduct. 

We can see no reason for any alteration in either Section 
1142 of the Penal Law of the State of New York, nor in Sec- 
tions 211 or 245 of the United States Criminal Law, but rather 
the certainty of untold harm should amendments limiting the 
scope of those laws be enacted. 

Virginia Terhune Van de Water 

Author, Pompton, N. Y. 
T DO believe strongly in intelligent Birth Control. But one 
trouble about this matter is that the better classes know how- 
to control the number of births in their families, — ^while the 
uneducated classes seem ignorant of any safe method of pre- 
venting large families. Therefore the poor women resort to 
quacks and to abortionists, and ruin their health. I knew one 
poor woman who procured eight miscarriages, because she 
could not afford to have children. Then she wondered that 



BIRTH CONTROL 203 

her health was wrecked! Yet had she heen instructed in safe 
and sane methods of prevention of conception she might have 
continued to be a well, strong, useful person. When I knew 
her, she was a regular attendant at a free clinic for internal 
disorders. She was incurably ill. 

In answering your numbered questions, I would say, — 

1. That over-population certainly seems to be a menace 
to the peace of the world, — probably one of the big factors 
in causing the World War. 

2. That legal dissemination of scientific Birth Control in- 
formation through clinics conducted by reputable physicians 
would be the wisest and safest way of checking over-population. 

3. That knowledge of scientific Birth Control would not 
change the moral attitude of men and women toward the mar- 
riage bond. In fact I fancy it would make them respect 
marriage more. Nor do I believe that it would lower the 
moral standards of our young people. They have certainly 
been lowered during the past few years without such knowledge 
of Birth Control as has been suggested. The fear of bringing 
illegitimate children into the world, or of giving birth to a 
diseased progeny has not kept the youth of our country moral. 
Plain speech on such matters would, in my opinion, make vice 
less attractive by removing all mystery from it and by show- 
ing it in all its hideous features. 

4. I believe that knowledge that enables parents to limit 
their offspring will increase human happiness and raise the 
standards of the entire population. Fewer and better children 
are needed, — children that are wanted and planned for instead 
of unwelcome "accidents." 

Prof. W. F. Willcox 

Cornell University 
T^HE great number of living persons and their rapid 
increase are not in themselves a serious menace to the 
peace of the world. The trouble is that in civilized countries 
the increase is derived in large and growing proportion from 
the less desirable stocks. The privileged classes are now exer- 



204 IS BIRTH CONTROL MORAL? 

cising Birth Control in increasing proportions and cannot be 
prevented from so doing. Since deliberate and desired parent- 
hood is the form which human reproduction is rapidly assum- 
ing and is on the whole conducive to a better race, it should 
and will be extended, though slowly, to all classes of popula- 
tion. Such a far reaching change is sure to modify profoundly 
the attitude of mankind toward marriage and parenthood. In 
some cases it will work ill, in others good. But the net result, 
I hope and believe, will prove to be a boon to mankind. Cer- 
tainly the effort to prevent or check this great change by en- 
forcing laws inherited from earlier stages of knowledge and 
morals is sure in the end to fail. 

STERILIZATION OF THE UNFIT 

By Norman Haire, M.B., CLM. 

The following letter from Dr. Norman Haire covers a somewhat different 

field from that suggested by the Questionnaire. It is a practical 

contribution from a doctor's own experience. 

ALTHOUGH Birth Control is gaining in public favor, 
it still has many active opponents — really earnest con- 
scientious people, who sincerely believe that it is wrong for 
averagely healthy men and women to limit their families. 

But there are few, I think, who would deny that it is justi- 
fiable, and indeed very desirable, to limit or prevent the mul- 
tiplication of those, who, through either physical or mental 
disease, are obviously unfit for parenthood. 

Especially in cases of mental disease is it necessary that re- 
production should be avoided; and it is precisely in these 
cases that it is most difficult to teach the patient to take regular 
and adequate precautions. Through indifl^erence, or careless- 
ness, or lack of intelligence, these people generally fail to 
avoid conception, so that they continue to bring into the world 
a new generation of human beings handicapped from the 
beginning by a woefully small mental bank balance, who be- 
come bankrupt if too great a demand is made on their poor 
resources. 

I was Resident Physician at three Australian Mental Hos- 



BIRTH CONTROL 205 

pitals and Resident Superintendent of a large Obstetric Hos- 
pital, and there I have often seen women who suffered from 
attacks of insanity regularly each time they were pregnant. 
During the pregnancy or at confinement they would become 
insane, and would be removed to an asylum. If they recovered 
sufficiently, they would be discharged as cured, to return with 
a similar attack at the next pregnancy. I have seen women 
who have had as many as six attacks of this sort, and who 
nevertheless were not prevented from becoming pregnant 
again, or even taught to take any contraceptive precautions. 

We investigated the family history of all cases admitted 
to the asylums, and in a very large proportion of them it was 
easy to trace further cases of mental disturbance in 
direct ancestors or in other near relatives. Often we would 
find insanity in several successive generations, the age of onset 
becoming earlier in each succeeding generation, showing that 
each individual tended to begin with less capital than its 
predecessor, and in the presence of an equal strain to become 
bankrupt earlier. 

At present I am Honorary Physician at a Maternity and 
Child Welfare Centre in a very poor part of London, where a 
good many cases show mental disturbance or deficiency, and 
it is in these cases that I find it most difficult to convince the 
parents of the necessity for contraception and to teach them 
properly to use the ordinary simple methods. 

In such cases, as also in the presence of Syphilis, Tuber- 
culosis and certain other diseases which may be transmitted 
to, or may damage, the offspring, sterilization by surgical means 
seems to me to be clearly indicated. In some of the states of 
the American Union the compulsory sterilization of lunatics 
and habitual criminals is prescribed or permitted by law, and 
I have been informed by the Secretary of the State Board of 
Health for Indiana that about twelve hundred male criminals 
have been sterilized in that state, and that sterilization laws 
exist in New York, Michigan, Oregon, California, Washington, 
Kansas, Illinois and Iowa. 

Public opinion in England is not yet ready to accept the 



206 IS BIRTH CONTROL MORAL? 

idea of compulsory sterilization, but I think there would be 
little effective opposition if voluntary sterilization were ad- 
vocated for such cases, and its simplicity and harmlessness 
properly explained. Indeed I believe that soon many men and 
women suffering from less serious physical or mental dis- 
ability, or from economic distress and even many who, while 
neither unhealthy nor poor, yet desired to limit their families 
from other motives, would also seek this operative relief; in 
order to avoid the constant necessity for troublesome temporary 
precautions, and the anxiety due to the fallibility of all ordin- 
ary contraceptive methods. 

Unfortunately, when one speaks of sterilization by opera- 
tion, the average English man or woman thinks that one 
means the actual removal from the body of the ovaries or 
testicles, with consequent loss of sexual desire and potency, 
and subsequent transformation into a neuter sort of person, 
lacking all interest and joy in life. 

This, of course, is not what is meant at all. Sterilization 
can be safely, easily and efficiently carried out by any com- 
petent surgeon. In the female a small incision is made in 
the abdominal wall, the Fallopian tube is tied in two places 
and cut in between. In the male the operation is even simpler, 
because the seminal duct or Vas Deferens is nearer the surface 
of the body. In this case a small incision is made in each 
groin and the male duct tied and cut across in a similar man- 
ner. In either case, the patient should be quite recovered 
from the operation in a fortnight. 

Surgical sterilization is far less painful and occasions less 
inconvenience than does a single confinement, to say nothing 
of the previous nine months of pregnancy. And it cannot be 
too strongly emphasized that the general health, sexual desire 
and sexual potency are in no way prejudiced by this operation 
in man or woman. 

Indeed, the recent work of Steinach, of Vienna, and of his 
co-workers and disciples, goes to show that this operation in 
the male is often followed by increased sexual desire and 
potency and by considerable improvement in health. 



THE AMERICAN BIRTH CONTROL LEAGUE, Inc. 

SHORTLY before the date of the Conference, the friends 
of the movement organized the American Birth Control 
League with the following officers and Executive Committee: — 

Margaret Sanger, President 

Juliet Barrett Rublee, Vice-President 

Anne Kennedy, Secretary 

Clara Louise Rowe, Corresponding Secretary 

Frances B. Ackermann, Treasurer 

Richard Billings, Assistant Treasurer 

EXECUTIVE COMMITTEE 
Dr. John C. Vaughan Dr. Lydia de Vilbiss 

Robert Morss Lovett Mrs. Pierre Jay 

AND officers OF LEAGUE 

Headquarters: 104 Fifth Avenue 

On April 22, 1922, the League received a charter of Incor- 
poration from the State of New York. At the initial meeting 
of the League, a statement of Principles and Aims was adopted 
as its platform and program of work. 

The statement was as follows: — 

PRINCIPLES: 

The complex problems now confronting America as the re- 
sult of the practice of reckless procreation are fast threatening 
to grow beyond human control. 

Everywhere we see poverty and large families going hand in 
hand. Those least fit to carry on the race are increasing most 
rapidly. People who cannot support their own offspring are 
encouraged by Church and State to produce large families. 
Many of the children thus begotten are diseased or feeble- 
minded; many become criminals. The burden of supporting 
these unwanted types has to be borne by the healthy elements of 
the nation. Funds that should be used to raise the standard of 

207 



I! 



208 AMERICAN BIRTH CONTROL LEAGUE 

our civilization are diverted to the maintenance of those who 
should never have been born. 

In addition to this grave evil we witness the appalling waste 
of women's health and women's lives by too frequent preg- 
nancies. These unwanted pregnancies often provoke the crime 
of abortion, or alternatively multiply the number of child 
workers and lower the standard of living. 

To create a race of well-born children it is essential that the 
function of motherhood should be elevated to a position of 
dignity, and this is impossible as long as conception remains 
a matter of chance. 

We hold that children should be 

1. Conceived in love; 

2. Born of the mother's conscious desire; 

3. And only begotten under conditions which render pos- 
sible the heritage of health. 

Therefore we hold that every woman must possess the power 
and freedom to prevent conception except when these condi- 
tions can be satisfied. 

Every mother must realize her basic position in human 
society. She must be conscious of her responsibility to the 
race in bringing children into the world. 

Instead of being a blind and haphazard consequence of un- 
controlled instinct, motherhood must be made the responsible 
and self-directed means of human expression and regeneration. 

These purposes, which are of fundamental importance to the 
whole of our nation and to the future of mankind, can only be 
attained if women first receive practical scientific education in 
the means of Birth Control. That, therefore, is the first object 
to which the efforts of this League will be directed. 

AIMS: 

The American Birth Control League aims to enlighten 
and educate all sections of the American public in the various 
aspects of the dangers of uncontrolled procreation and the 
imperative necessity of a world program of Birth Control. 

The League aims to correlate the findings of scientists, statis- 
ticians, investigators and social agencies in all fields. To make 



BIRTH CONTROL 209 

this possible, it is necessary to organize various departments: 

RESEARCH: To collect the findings of scientists, concern- 
ing the relation of reckless breeding to delinquency, defect and 
dependence. 

IIWESTIGATION: To derive from these scientifically as- 
certained facts and figures, conclusions which may aid all pub- 
lic health and social agencies in the study of problems of 
maternal and infant mortality, child-labor, mental and physical 
defects and delinquence in relation to the practice of reckless 
parentage. 

HYGIENIC AND PHYSIOLOGICAL instruction by the 
Medical profession to mothers and potential mothers in harm- 
less and reliable methods of Birth Control in answer to their 
requests for such knowledge. 

STERILIZATION of the insane and feeble-minded and the 
encouragement of this operation upon those afflicted with in- 
herited or transmissible diseases, with the understanding that 
sterilization does not deprive the individual of his or her sex 
expression, but merely renders him or her incapable of pro- 
ducing children. 

EDUCATIONAL: The program of education includes: The 
enlightenment of the public at large, mainly through the edu- 
cation of leaders of thought and opinion — ^teachers, ministers, 
editors and writers — to the moral and scientific soundness of 
the principles of Birth Control and the imperative necessity of 
its adoption as the basis of national and racial progress. 

POLITICAL AND LEGISLATIVE: To enlist the support 
and co-operation of legal advisors, statesmen and legislators in 
effecting the removal of state and federal statutes which en- 
courage dysgenic breeding, increase the sum total of disease, 
misery and poverty and prevent the establishment of a policy 
of national health nd strength. 

ORGANIZATION: To send into the various States of the 
Union field workers to enlist the support and arouse the in- 
terest of the masses to the importance of Birth Control so that 
laws may be changed and the establishment of clinics made pos- 
sible in every State. 



210 AMERICAN BIRTH CONTROL LEAGUE 

INTERNATIONAL: This department aims to co-operate 
with similar organizations in other countries to study Birth 
Control in its relations to the world population problem, food 
supplies, national and racial conflicts, and to urge upon all 
international bodies organized to promote world peace, the 
consideration of these aspects of international amity. 

THE AMERICAN BIRTH CONTROL LEAGUE proposes to 
publish in its official organ The Birth Control Review, reports 
and studies on the relationship of controlled and uncontrolled 
populations to national and world problems. 

The American Birth Control League also proposes to hold 
an annual Conference to bring together the workers of the 
various departments so that each worker may realize the inter- 
relationship of all the various phases of the problem, to the 
end that National education will tend to encourage and develop 
the powers of self direction, self-reliance, and independence in 
the individuals of the community instead of dependence upon 
public or private relief of charities. 



INDEX 



Adams, S. H 179 

American Birth Control 

League 207 

Anthony. K 180 

Austria, Birth Control in 151 

Barker, E. C 180 

Bell, B. I 181 

Bennett, Mrs. M. T 53, 160 

Birth Control Not Abor- 
tion 18 

Birth Control in Its Rela- 
tion to Disease 31 

Bland, J. 0. P 82 

Bowen, E. W 182 

Bushee, F, A 182 

Butler, Dr. Alice 37 

Butler, Pearce 182 

Cannon, W. B 183 

Carpenter, E 176 

Committee, Birth Control 

Conference 1 

Conscience and Birth Con- 
trol 46 

Cox, Harold 4, 120, 121 

on War and Population... Ill 
on Is Birth Control Moral 164 

on Freedom of Speech 169 

Delinquent Woman, Problem 

of the 60 

DeVilbiss, Dr. L. A., 39, 122, 163 

Dilla, Dr. H. M 5, 74 

Disarmament, Birth Control 

and 123 

Discussion 48, 85, 119 

Drysdale, Dr. C. V 123 

Durant, Will 184 

Dutch Opinion 148 

Ellis, Havelock 177 

Eugenic Aspect of B. C 56 

Exhibits 5 



Ferch, Johan 155 

Fite, Warner 184 

Freedom by B. C, The 

Greater 74 

Gibbons, Mr 146 

Giddings, F. H 186 

Goldstein, Dr. S. E 147 

Gruening, E. H 186 

Haire, Dr. Norman 204 

Hamilton, Cosmo 188 

Hine, Lewis 5 

Hirshfield, Comr 163 

Holland and B. C 133 

Holmes, John Haynes 188 

Hooker, Edith H 

12, 85, 94, 123 159 

Hurst, Fannie 189 

Hussey, Dr 122 

Infant Mortality, B. C. and. 102 

Inge, Dean 177 

Johnson, Roswell H 56, 158 

Johnson, Dr 52 

Johnston, Mary 190 

Jones, Mr 121 

Jordan, David S 190 

Knopf, Dr. S. A 31, 49 

Konikow, Dr 87 

Lewis, Mr 158, 160 

Liber, Dr. Benzion 48 

Limitation of Armaments 157 

Lindeman, Prof. E. C 66 

Lindsey, Ben. B 191 

Little, Dr. C. C 58 

Lovejoy, Owen R 193 

Malthus, T. R 22 

Marsh, Robert 163 

Maurer, James 102 

Medical Aspects of B. C 39 

Mental Disease, Inheritance 
of 36 



211 



212 



INDEX 



Merchant, Mr 85 

Mitchell, Mrs 146 

Moens, H. M. B 148 

Myer, Adolph 46 

Myerson, Dr. Abraham 36, 51 

Neo-Malthusian Formula 135 

Order of Birth and Sex 

Ratio 58 

Patrick, Dr 49 

Paul, E. and C 193 

Peabody, G. F 195 

Pell, C. E 195 

Petitions 157, 158 

Population Problems in Asia 94 
Population Question in Asia. 82 

Principles and Aims 207 

Programme of Conference_3, 9 
Psychiatric Standpoint, B. 

C, from a 53 

Psychoanalysis, B. C. and_._ 139 
Public Health Measure, B. 

C, as a____ 29 

Public Meeting 4, 163 

Questionnaire 4, 175 

Reiland, Dr. Karl 163 

Robie, Dr. W. F 139, 159 

Rosanoff, Dr. Aaron J 53 



Rowe, C. L 157 

Rublee, Juliet Barrett 163 

Rural Social Progress, B. C. 

and 66 

Sanger, Margaret 

1, 4, 111, 121, 123, 138, 146 

Opening address of 14 

Speech at Park Theater. _ 170 

Scharlieb, Mary 19H 

Sentiment against B. C, 

Some Sources of 21 

Simkhovitch, M. K 200 

Spaeth, Reynold A 29 

Sterilization of the Unfit 204 

Stoddard, Lothrop 94 

Sumner, John S 200 

Telegrams sent by Conference 94 

Todd, Helen 119, 120 

Van de Water, V. T 202 

Vaughan, Dr. J. C 18. 52 

War and Population 111 

Wattal, P. K 97 

Willcox, W. F 203 

Winsor, Mary 4,151, 163 

Woman's Need of B. C, The 

Individual 37 

Young, Virginia C 60 



